February 11, 2009

Exclusive: The protest has ended so there will be no further delays. Yellow states up first –-CMS

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The Recovery Audit Contractor program will not change from its original design, according to a written statement submitted to RACMonitor by The Centers for Medicare & Medicaid Services on Tuesday (Feb. 10, 2009).

 

Connie Leonard, director of the CMS Division of Recovery Audit Operations, said the protest period has ended so there will be no further delays. The yellow states will begin implementation immediately.

 

The originally awarded contracts to the four RACs remain in place. Those include the following:

 

  • Region A: Diversified Collection Services, Inc. (of Livermore, Calif.)
  • Region B: CGI Technologies and Solutions, Inc. (Fairfax, Va.)
  • Region C: Connolly Consulting Associates, Inc. (Wilton, Conn.)
  • Region D: HealthDataInsights, Inc., (Las Vegas, Nev.)

 

"Companies use subcontractors for a variety of reasons," said Leonard. "Given the span of the RAC contracts, it is not unexpected for a company to utilize subcontractors."

 

According to CMS, PRG-Schultz, Inc. will serve as subcontractor to HDI, DCS and CGI in regions A, B and D; Viant Payment, Inc. will serve as subcontractor to Connolly Consulting in region C. Each subcontractor has negotiated different responsibilities in each region, including some claim review.

 

"The companies decided to work on a settlement that enabled all of the companies to participate in the RAC program," said Leonard. CMS only consented to the subcontracting agreement because it will enhance the RAC program."

 

On Nov. 4, 2008, CMS announced it had been required under the Competition in Contracting Act to place an automatic stay on the contract work of the RAC program as a result of two protests filed with the GAO by Viant and PRG-Schultz USA, Inc., two companies challenging the awarding of contracts.

 

Both Viant and PRG withdrew their protests last week, and the GAO closed the files for each without further action, according to a written statement submitted by the GAO to RACMonitor.com.

 

"Over the course of the next several months, CMS will begin contacting associations and providers to discuss provider outreach sessions involving the RAC contracts," said Leonard.  "CMS will post the outreach schedule very soon at www.cms.hhs.gov/rac."

 

CMS provided RACMonitor with the following program highlights:

 

  • CMS will be establishing provider outreach sessions in conjunction with the RACs

  • CMS will begin scheduling such sessions over the next few weeks

  • Providers will not begin receiving correspondence from a RAC until the RAC and CMS have completed provider outreach

  • Implementation begins March 1 for Green states

  • CMS does not anticipate altering the outreach time frames

 

In a three-year demonstration, RACs corrected more than $1.03 billion of improper Medicare payment. Of that amount, CMS says approximately 96 percent was overpayments collected from providers and a scant 4 percent was underpayments repaid to providers.

 

For additional information come to www.racbystate.com

 

 

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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