Corporate Compliance

CMS announces RACs, program improvements

Healthcare Auditing Weekly, October 14, 2008

CMS recently announced recovery audit contractor assignments for its permanent RAC program, making the arrival of RACs a reality for 19 states this fiscal year.
 
CMS listed the following contractor assignments in a fact sheet October 6: 
  • Region A: Diversified Collection Services, Inc. of Livermore, California, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and New York. 
  • Region B: CGI Technologies and Solutions, Inc. of Fairfax, Virginia, initially working in Michigan, Indiana, and Minnesota.
  • Region C: Connolly Consulting Associates, Inc.  of Wilton, Connecticut, initially working in South Carolina , Florida , Colorado, and New Mexico .
  • Region D: HealthDataInsights, Inc. of Las Vegas, Nevada, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah, and Arizona.
CMS also mentioned in the fact sheet the many lessons they learned during the demonstration. They hope to use the demonstration experience to make improvements to the permanent RAC program. CMS gave one example in the fact sheet stating:

"The program will be more transparent by listing the types of issues undergoing review on each of the RACs’ Web sites. Each RAC will also employ a full-time medical director to help in the review of claims."

CMS also gave the following tips for providers who will soon receive requests from RACs for medical records: 
  • Conduct an internal assessment to ensure that submitted claims meet the Medicare rules.
  • Identify where improper payments are most common in your facility as well as patterns of denied claims in your facility.
  • Implement procedures to promptly respond to RAC requests for medical records.
  • File appeals before the 120-day deadline.
  • Keep track of denied claims and correct errors.
  • Determine what corrective actions your facility needs to take to ensure Medicare compliance and avoid submitting incorrect claims in the future.

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