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South Carolina RAC

HMS® (hms.com) is under contract with the State of South Carolina Department of Health and Human Services (SC DHHS) as South Carolina’s Medicaid Recovery Audit Contractor pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010. Accordingly, HMS is authorized to audit provider payments and associated financial records for claims to identify underpayments and overpayments, and to recover any overpayments made to providers.

HMS has identified the following targets to date:

Complex Review Targets

  • Medical necessity
  • Short stays
  • DRG
  • Readmissions

Semi-automated Review Targets

  • Ambulance during inpatient stay
  • Pulmonary diagnostic procedures and E&M services
  • Readmissions within 24 hours with the same DRG

Resources for South Carolina