title: Get ready for more headaches as Medicaid RACs are ramped up.
abstract: The Medicaid Recovery Audit Contractors (RAC) program is going to be a challenge for hospitals because each state has a different set of rules, different auditors, and different appeals processes. Since Medicaid agencies are always short of funds, the auditors are likely to be aggressive. Case managers must review all patients at point of admission, apply the same criteria, and make sure that documentation is detailed and complete. If a hospital treats patients from more than one state, case managers need to be familiar with the rules and regulations of each state's Medicaid program. Medical necessity for one-day stays is likely to be a major focus of the Medicaid RACs.
mesh_terms: D019090:Case Management; D004469:Economics, Hospital; D007345:Insurance Claim Review; D008484:Medicaid; D020416:Outsourced Services; D014481:United States