December 17, 2008

RAC's Expected to Target First Wave States

By

sdonio120dsBy: Samuel A. Donio, Jr., MBA

Even though RACs are on hold for the moment, more than a dozen states are in the CMS crosshairs when the program resumes sometime in February of next year.

But don’t expect RAC auditors to show up and request to see medical records right away. RAC activity for first wave states is what CMS is calling ‘provider outreach and education.’ In other words, before contractors come calling, CMS will first prepare information for Medicare providers as to what to expect when the program is phased in nationally.

 

Essentially, CMS will pick up where it left off on November 4, 2008, when the program was put on automatic stay because of a contractor dispute.

When the program does resume, RACs are expected to hold town hall type meetings in each state with Medicare providers, CMS staff and RAC representatives.
CMS said it would also continue to work “closely with national and state medical, hospital and nursing home associations to strengthen relationships to be more proactive and anticipate the needs and concerns of health care providers.” 
Those associations in the first wave of states include the following:

 

Region A

  • New Hampshire Hospital Association
  • Greater New York Hospital Association
  • Healthcare Association of New York State
  • Maine Hospital Association
  • Massachusetts Hospital Association
  • Vermont Hospital Association
  • Rhode Island Hospital Association

 

Region B

  • Indiana Hospital Association
  • Michigan Health Association
  • Minnesota Hospital Association

 

Region C

  • Oncology State Society Network, Albuquerque, New Mexico
  • New Mexico Hospital
  • South Carolina Hospital Association
  • Rehab Service Palmetto Health Baptist, South Carolina
  • Colorado Hospital Association
  • South Florida Hospital Association
  • Florida Hospital Association

 

Region D

  • Montana Hospital Association
  • Wyoming Hospital Association
  • Utah Hospital Association
  • North Dakota Hospital Association
  • South Dakota Hospital Association
  • Arizona Hospital Association

 

Upon completion of RAC provider education, CMS says that some healthcare organizations in first wave states may receive either requests for medical records or a letter requesting that an overpayment be repaid for their claims that were submitted to and paid for by Medicare.

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Samuel A. Donio, Jr. is president of CBIZ KA Consulting Svcs, LLC

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Samuel A. Donio, Jr., MBA

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