(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

3.15.30 Proposed Compensation Tables and Proposed Fixed Fee Rates Schedule
(Attachment A)
The Proposed Compensation Tables and Proposed Fixed Fee Rates Schedule are included in
Appendix A. Instructions for completing each Compensation Table and the Proposed Fixed Fee
Rates Schedule are given in the following sections.
3.15.31 Proposed Compensation Table 1
Proposed Compensation Table 1 depicts the first proposed payment methodology with the
Respondent taking into consideration the audit result (overpayment or underpayment) and the
level of difficulty of the review (automated or complex). A review will be considered automated
if the RAC did not need to examine medical documentation to determine the existence of an
improper payment, and it will be considered complex if the RAC did examine medical
documentation to determine the existence of an improper payment.
3.15.32 Proposed Compensation Table 2
Proposed Compensation Table 2 depicts the second proposed payment methodology with the
Respondent taking into consideration the “Blended Rate” methodology, which is defined as a
single contingency percentage that will be applied to all reviews regardless of the audit result
(overpayment or underpayment) or the level of difficulty of the review (automated or complex).
This percentage will be applied to the total overpayments recovered and the underpayments
discovered and paid to determine the contingency fee payable by HHSC to the RAC for all
applicable improper payment audits.
3.15.33 Proposed Compensation Table 3
Proposed Compensation Table 3 depicts the third proposed payment methodology with the
Respondent taking into consideration the “Tiered” methodology, which provides numerous
possible contingency percentages that each take into consideration a specific audit result
(overpayment or underpayment), level of difficulty of the review (automated or complex), and
the dollar value of the recovery audit under review. Based on these three variables, the
appropriate contingency percentage will be located on the fee table provided by the RAC. This
percentage will be applied to the overpayments recovered or the underpayments discovered
and paid to determine the contingency fee payable by HHSC to the RAC for that specific
improper payment audit.
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