Revenue Cycle

CMS RAC Open Door forum update

Recovery Auditor Report, November 13, 2008

During the November 12 RAC Open Door Forum for Part A providers, CMS announced its intent to do the following with the permanent RAC program:
  • Minimize hassles for providers. This includes limiting the volume of medical records RACs may request, and allowing RACs to look back three years instead of four.In addition, CMS is requiring RACs accept imaged records on CD/DVD.
  • Maximize transparency. Among other steps, CMS has made it mandatory for RACS to have a Web site showing status of every claim by 2010, as well as send out detailed letters to providers reviewing results. The Web sites will also post types of audits as well as vulnerabilities.
  • Maximize accuracy. CMS has required RACs to have medical directors and certified coders (i.e., coders with CCF, CCA, CCSP, CPC, CPC-H, or CRNC credentials).

In addition, during the call, CMS recommended providers take certain steps to prepare for the permanent RAC program. Suggested steps include the following:

  • Review and understand all documents from the RAC demonstration
  • Review all findings by permanent RACs once the program begins
  • Review all current OIG reports at www.oig.hhs.gov/reports.asp
  • Review the information on the CMS Comprehensive Error Rate Testing (CERT) Web site at www.cms.hhs.gov/cert
  • Put in place an internal audit program
CMS also confirmed that the only twp types of claims that are not open for review by RACs are HMO Medicare (Part C) and prescription drug (Part D) claims. 

CMS will be holding a special RAC Open Door Forum for Part B providers Thursday, November 13, at 2:00 p.m., ET. If you missed the similar call for Part A providers November 12, a recording will be available on the CMS Web site beginning November 19.

Tip: If you plan on dialing in for the RAC Open Door Forum call for Part B providers on November 13, do so early. You may dial in as early as 1:45 p.m. ET. The November 12 call reached maximum capacity well before 2:00 p.m. ET.

Comments

1 comments on “CMS RAC Open Door forum update

Eriko (6/4/2012 at 3:39 PM)
These first issues are the aumoatted issues- stuff they can find with a computer like billing for two hysterectomies, doing two colonoscopies in one day, billing for Neupogen by the number of mg given not the number of vials, etc. The real fun comes later when they start looking at whether patients should have been admitted to the hospital rather than Observation or if the hospital billed for an inpatient stay for an ICD placement or cardiac cath when Observation status was more appropriate. These will be very subjective determinations and will earn the RAC's lots of money with each denial.

 

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