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I find it very interesting that when Medicare was interviewed (she seemed rather inept at her job) the lady never once mentioned RAC. Do you know what RAC is? Ask any Certified Professional Coder in the U.S.(I am one), they will tell you it stands for Recovery Audit contractor.

Why is that important? Well....the Federal government put audit jobs up for bid, they hired 4 companies to audit all claims. They are expected to return about $6 billion over the next year. How can they do this? They will have as much power as they need to hit every hospital, every doctor's office, ever DME office anyone who bills Medicare, demand an audit and can pend payments on what they call a Pre Pay Review.

How do I know this? Google the CMS website go look at the RAC update. I wonder why the Medicare lady never mentioned this great new program?

Medicare has been bilked out of their money because they are a government run agency who most likely costs as much to run as it lost. It was lost because of poor management.

Last item up for grabs is that these 4 RAC companies have a huge incentive to do their job and do it aggressively. They will collect I believe it is 4% of everything they can get for Medicare. Billions of claims the Medicare lady said are billed out, the convict claimed hundreds of thousands of claims. Do the math RAC will not only make billions but get Medicare billions back in their bank account. I am not feeling too sorry for them.

Who will pay it? Well, the ones that cheated obviously but many good hospitals and good doctors will be hamstrung in the process scrambling to get documents processed and back to the auditor praying they still get paid. Then fight with them if RAC still says no we are not paying you, the appeals process will still hold their money up.

Yup, this is gonna get real interesting.