August 16, 2013

RAC Transition Timeline Again Pushed Back by CMS

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WASHINGTON, D.C. –- The deadline by which Recovery Audit Contractors (RACs) are required to stop issuing additional documentation requests (ADRs) to providers in advance of a transition to new contractors has been pushed back a second time, sources confirmed this week.

The Centers for Medicare & Medicaid Services (CMS) announced in May that it was going forward with such a transition, and initially, RACs were to stop making ADRs by May 31, but that deadline later was extended to June 30. Last week, HMS Holdings (HMSY) and Performant reported, the deadline was pushed back yet again, this time to Nov. 15.

By the end of January 2014, RACs are expected to be directed to stop sending improper payment claims to CMS altogether. New RAC contracts have yet to be awarded, and the most recent deadline extension appears to suggest that such a move likely won’t occur before the middle of next year.

“Under the amended transition plan, each Medicare RAC will remain responsible for assisting CMS with the appeals process, and returning fees previously paid on successful appeals, for their current region through December 31, 2015,” HMSY reported in a brief release, citing a modification of the RAC contract currently held by HealthDataInsights, the Region D contractor.

“As it relates to the Medicare RAC contract and renewal process, CMS continues to work through the transition from the first to the second contract,” a transcript of the most recent Performant earnings call added.

The deadline shift was viewed by Performant as a “positive,” but the company expressed concern regarding the CMS decision to restrict all RACs from sending medical record requests to the Periodic Interim Payments (PIP) providers until further notice. About 20 percent of the hospitals in Performant’s region fall under such an umbrella, the company noted.

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Mark Spivey is a national correspondent with the RACmonitor.

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor and ICD10monitor who has been editing and writing reports for the websites for eight years.

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