Home Health & Hospice

Do You Think ORT When You Hear RAC?

Homecare Insider, November 16, 2009

Experienced homecare administrators and directors have one concern weighing heavily on their minds.  

Is this whole Recovery Audit Contractor (RAC) thing going to turn into another Operation Restore Trust (ORT)?  I don’t ever want to live through another review like that.

Those sage individuals that have been in home health care since the mid-1990s can relate to the fear this director feels.  There are similarities between ORT and the RAC program.  The government kicked off ORT in 1995 to identify and prosecute fraudulent activities in five states.  Just like the RAC demonstration, ORT was so successful that it spread like wildfire across the country.  It was evident that ORT surveyors were not experts in Medicare coverage criteria for home health care.  The ORT sampling methodology was greatly flawed and extrapolation put many agencies on the brink of bankruptcy.

However, there are some significant differences.  The Centers for Medicare and Medicaid Services (CMS) is limiting both the number of records RACs can review and the time period for review.  A RAC must obtain CMS approval of issues for review and post them to a Web site.  RACs must employ certified coders, nurses, therapists, and a medical director and apply CMS regulations and coverage criteria in the review process.  Providers can ask to see the credentials of the reviewers.  And there is an appeals process.  With this defined structure, we can all hope that the reviews will be more civilized and fair.

“Mastering Medicare in 2010” will identify RAC risks and red flags and provide strategies to help your agency get ready for the reviews.  Click here to learn more about this new seminar.