August 9, 2012

RAC Coordinators Have New Ally in FISS

By

I am fortunate enough to participate in a quarterly meeting of facility RAC coordinators in the state of Wisconsin. What began as a small working group barely fitting around a conference room table by now has expanded to roughly 50 participants attending either in person or by telephone.

The 2012 fiscal year has been a challenging one for RAC coordinators across the country. Due to a change in the responsibility for issuing demand letters from the four RAC contractors to the Medicare Administrative Contractors (MACs), review information that once easily was obtained now is nearly impossible to track. This has necessitated that coordinators nationwide find alternative means to track an ever-increasing workload.

At the most recent coordinators’ meeting, attention was directed to the Fiscal Intermediary Standard System, commonly known as FISS. The FISS is a mainframe system MACs use to process Medicare Part A claims across the nation, including outpatient claims submitted under Part B. Claims are entered, corrected, adjusted or canceled within FISS. The system also processes inquiries for claim status, additional development requests, eligibility and/or codes.

In the new RAC tracking reality created by the demand letter policy change, the FISS system can be an incredible ally to a RAC coordinator. Because it is a shared system, any adjustments on claims made due to RAC activity are entered into the database and can be viewed by those with access within a facility. Specific to RACs, the system stores additional documentation requests, which can be retrieved and either viewed or printed with minimal effort. Via specified reason codes, the system also offers information about full-claim or single-line denials related to RAC activities. Any changes in claim information stemming from an automated denial also can be found within the system. All of this information is accessible with the entry of an NPI number, a Health Insurance Claim (HIC) number and the “from” and “through” dates of service for the claim for which a coordinator is seeking information.

The FISS also will offer an advantage in those states where RAC prepayment demonstration audits begin on Aug. 27. If a claim has been reviewed for medical necessity and denied prior to payment, the reviewer of the claim is tasked with entering a note in the system explaining any review determinations. Given the differences in demand letter reporting requirements as compared to the original RAC Demonstration Project, the FISS will be an invaluable source of information. It is important to remember that claims pulled as part of the demonstration project will be live claims, so providers will not be able to change any claim information through the FISS for these claims.

Novitas Solutions recently concluded a three-part webinar series on uses and navigation of the FISS system. The material constitutes the most complete source of available information regarding the system.

While requesting access to the system and subsequently familiarizing yourself with the information provided by FISS will take some time, the process will assist greatly in the tracking of RAC activity. Based on the volume of RAC activity discussed among members of the Wisconsin’s RAC Coordinators Group, the FISS is a long-overdue source of information.

About the Author

J. Paul Spencer is the Compliance Officer for Fi-Med Management, Inc., a national physician practice financial management company based in Wauwatosa, WI. Paul has over 20 years of experience across all facets of healthcare billing, including six years spent with insurance carriers. In his current role with Fi-Med, he acts as a physician educator on issues related to E/M level of service and documentation audits by CMS and other outside entities. Paul has carried the CPC and CPC-H credentials from the American Academy of Professional Coders since 1998.

Contact the Author

pspencer@fimed.com

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J. Paul Spencer, CPC, COC

J. Paul Spencer is a senior healthcare consultant for DoctorsManagement. Is the national correspondent for Monitor Mondays, the live Internet radio broadcast produced by RACmonitor.

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