Revenue Cycle

Key differences in nationwide rollout

Recovery Auditor Report, October 30, 2008

Editor’s note: In the last edition of The RAC Report, we highlighted some of the major differences between the three-year demonstration project and the permanent project. Here are some more, as highlighted on page 25 of CMS’s demonstration evaluation report.

Vulnerability reporting

Demonstration RACs: Limited

Permanent RACs: Frequent and mandatory

Standardized base notification of overpayment letters to providers

Demonstration RACs: Not required

Permanent RACs: Mandatory

Look back period (from claim date to date of medical record request)

Demonstration RACs: 4 years

Permanent RACs: 3 years

Time frame for paying hospital medical record photocopying vouchers

Demonstration RACs: None

Permanent RACs: Within 45 days of receipt of medical record

Quality assurance/internal control audit

Demonstration RACs: No

Permanent RACs: Mandatory

Reason for review listed on request for records letters and overpayment letters

Demonstration RACs: Not required

Permanent RACs: Mandatory

Public disclosure if RAC contingency fees

Demonstration RACs: No

Permanent RACs: Yes

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