Bill > SB314

This bill modifies the Recovery Audit Contractor (RAC) Program in Colorado, establishing detailed regulations for how Medicaid audits will be conducted. The bill defines key terms like "automated audit" (a review of coding rules without medical record submission) and "complex audit" (a review requiring medical record submission), and sets specific parameters for how these audits can be performed. The legislation limits the number of audits a provider can undergo annually, with different thresholds based on the provider's Medicaid revenue, and requires RAC vendors to follow strict procedural guidelines. Importantly, the bill mandates that RAC vendor compensation be contingent on recovered overpayments, with contingency fees capped at 16%, and establishes a comprehensive process for providers to challenge audit findings, including preliminary findings notifications, exit conferences, and informal reconsideration meetings. The bill also requires the state department to ensure RAC vendors use appropriately licensed and qualified staff, follow relevant billing guidelines, and conduct audits fairly and consistently. Additionally, the legislation restricts the lookback period for audits to three years after the timely filing period, with some exceptions for federal audit requirements, and provides protections to prevent excessive or overly burdensome audits for healthcare providers.

Budget and Finance

https://leg.colorado.gov/bills/sb25-314