Georgia Navigator Practice Exam

What is the primary role of Recovery Audit Contractors (RACs) working for CMS?

1. To provide healthcare services directly

2. To conduct reviews of payments under Medicaid and Medicare

3. To manage healthcare providers and facilities

4. To set insurance premiums for beneficiaries

The correct answer is: To conduct reviews of payments under Medicaid and Medicare

The primary role of Recovery Audit Contractors (RACs) working for the Centers for Medicare & Medicaid Services (CMS) is to conduct reviews of payments under Medicaid and Medicare. RACs are tasked with identifying and correcting improper payments within these federal healthcare programs. They focus on ensuring that healthcare providers are appropriately reimbursed for services rendered while also aiming to recover overpayments made in error, thereby protecting the financial integrity of these programs. This function is crucial for maintaining the accountability and accuracy of the reimbursement process. By identifying instances of overbilling or incorrect coding, RACs contribute to minimizing waste and fraud within the Medicare and Medicaid systems, ultimately benefiting the healthcare ecosystem and ensuring that funds are used for legitimate patient care.