Revenue Cycle

CHANGES COMING: Key differences in nationwide rollout

Patient Access Weekly Advisor, October 29, 2008

Now that you know which Medicare Recovery Audit Contractor (RAC) will come to your facility, it’s time to prepare for some changes. CMS revamped the program after the three-year demonstration project, and providers can expect to see the changes reflected in the nationwide permanent program.

Chief among them are:

RAC medical director

Demonstration RACs: Not required

Permanent RACs: Mandatory

Coding experts

Demonstration RACs: Optional

Permanent RACs: Mandatory

Credentials of reviewers provided upon request

Demonstration RACs: Not required

Permanent RACs: Mandatory

Discussion with CMD regarding claim denials if requested

Demonstration RACs: Not required

Permanent RACs: Mandatory

AC validation process

Demonstration RACs: Optional

Permanent RACs: Limited

External validation process

Demonstration RACs: Not required

Permanent RACs: Mandatory

Editor’s note: For more differences in the permanent program, see the next edition of Patient Access Weekly Advisor Nov. 5, 2008.

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