Revenue Cycle

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Recovery Auditor Report, February 19, 2009

CMS announced February 6 the permanent RAC program is once again underway as the RAC bid protests filed by Viant, Inc., and PRG Schultz, USA, Inc. have been withdrawn. Viant and PRG’s protests were resolved February 4, which means the stop work order has been lifted, according to CMS.

The Government Accountability Office (GAO) had 100 days to issue a decision after the unsuccessful bidders filed their protests November 4, 2008. The GAO had been set to render a decision on the protests on February 9 for Viant, and February 11, for PRG Shultz.

As a result of the protest settlements, these RACs will be subcontracting with PRG-Schultz and Viant. (PRG-Schultz will work with Diversified Collection Services in Region A, CGI in region B, and HealthDataInsights in Region D. Viant Payment Systems will work with Connolly Consulting in Region C.) PRG-Schultz and Viant will have different responsibilities—including possible claim review—in the various regions.

In the meantime, CMS has published a revised RAC expansion schedule as seen in the new "RAC Phase In Map" posted February 10 to the CMS Web site. The first phase is set to begin March 1. The second and final stage will begin August 1, according to the map. The prior expansion schedule was set to occur in three stages, however, the protests delayed the initial onset of the permanent RAC program.

CMS plans to begin audit activity in May for the states involved in the March phase-in, according to an American Hospital Association (AHA) February 11 news release in AHANewsNow. CMS will spend time between now and May conducting RAC educational sessions for hospitals, according to the AHA.

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