August 5, 2014

Small Contract Gains for RACs

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The Centers for Medicare & Medicaid Services (CMS) signed contracts last week with the incumbent RAC contractors to provide limited Recovery Audit services through April 30, 2016, according to Monitor Mondays legislative analyst Emily Evans. 

Evans, a partner with the Obsidian Research Group, said the contracts, valued at around $200,000, would be for limited RAC services. 

“RACs will be permitted to handle complex and automated reviews for claims related to spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics, supplies, and cosmetic procedures,” said Evans. “This contract extension calls into question the status of a new DMEPOS contract that was expected to be awarded sometime this summer and suggests that CMS is not ready to award new contracts for the program.”

A posting on the CMS webcast yesterday stated that “due to the continued delay in awarding new Recovery Auditor contracts, the CMS is initiating contract modifications to the current Recovery Auditor contracts to allow the Recovery Auditors to restart some reviews.”

CMS said most reviews would be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS.

“Work continues on the procurement process for the four Part A / Part B Regions and the national DMEPOS/HH&H Region,” the posting read. “The CMS remains hopeful that the new round of Recovery Auditor contracts will be awarded this year.”

In the meantime, senior Monitor Mondays correspondent Nancy Beckley, long associated with issues dealing with rehabilitation compliance services, expressed reservations about the CMS announcement. 

“It is not quite clear if CMS is in a race to the start or a race to the finish on Recovery Audit activity, based upon their announcement for limited automated and complex reviews utilizing the exiting contractors,” Beckley told RACmonitor. 

“Outpatient therapy reviews at $3,700 therapy thresholds were mandated by law, but assigned to the RACs by CMS,” said Beckley. “While the RAC program has been in a ‘pause,’ all claims over $3,700 have been piling up awaiting the start of the next round of recovery auditor reviews.”

Beckley, in considering the problems with manual medical review of therapy claims reported by providers, recommends all outpatient therapy providers get acquainted with the newly appointed CMS Provider Relations Coordinator Latesha Walker in order to secure support and assistance for paperwork and communication, starting with the specific ADR letter for outpatient therapy manual medical review.

About the Author

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

Contact the Author

cbuck@panaceainc.com

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Reference

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html

Chuck Buck

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

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