Updated on: January 29, 2013

Waiting to Exhale…

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Original story posted on: May 21, 2010

nbeckleyThe first in a series of RAC 101 calls begins tomorrow. Are you still holding your breath waiting for the RAC shoe to drop at your facility?

As recently reported in RACMonitor, CMS has announced a schedule of informational meetings called, interestingly enough, RAC 101. During the initial RAC rollout process all providers eagerly awaited such informational meetings, conference calls and webinars, which featured the participation of CMS representatives along with regional RAC representatives.

In some regions there was initially a bit of panic, because hospital association and medical society sponsors of the meetings were limiting registration to members only. In other instances reservations were required, as meeting rooms were limited by capacity. Following the initial rollout other trade associations joined in, such as those representing equipment dealers and the long-term care industry. The panic soon died down and the attention turned to discussion of the issues being approved for automated review.

With the permanent RAC program now underway in all regions, the information panic is largely gone, being replaced by a process panic for those deep in the midst of medical record requests for DRG and discharge validations. Industry experts also have  advised that the medical records providers are sending to the RACs right now likely will assist the RACs in preparing for medical necessity reviews, for which the stakes are higher for both parties.

"Repeating" RAC 101

For those who attended the initial RAC rollout sessions there may be a sense of complacency, since CMS basically has stated that it is RAC 101, not RAC 201. However, if your facility has not seen much RAC action (or no action at all so far), this is certainly a good time for a refresher. You will have to trudge through all the background information, history and maps, but even one new tidbit can be of benefit, especially for new people on your facility's RAC team.

This time around, beginning tomorrow and continuing through May, calls are being made by industry (a general call will be followed by one for home health & hospice, DMEPOS, and physicians) rather than by region, so there may be more specific details than previously provided. Of course, value also may come from being able to get in the Q&A queue to ask a question. The transcripts generally are published within a few weeks of the broadcast, so that will serve as another reference.

Tips for Passing the Time

Medicare Administrative Contractors have been updating their Web sites with information that is helpful in fostering understanding of the RAC process, so it is advisable to check what has been posted by your contractor. A recent check of contractor Web sites has revealed a few interesting tidbits:

  • Trailblazer has a RAC area that is updated routinely and highlighted in their e-mail updates. Trailblazer also recently posted a "Partners in Compliance" manual that details the CERT, ZPIC, and RAC, as well as NCCI and MUE edits. It is certainly worth a read if Trailblazer is your MAC.
  • Highmark has a section on Medicare Appeals that'ssure to come in handy in the RAC program. There are useful "timeline" calculators that let you know the timeframes for appeals if you are not using a RAC software management application. Use the calculators for the second and third levels.
  • Cahaba and other MACs have included the RAC program as part of their formal agendas for "Ask the Contractor" teleconferences.

If you are still holding your breath, grab a beverage and a box of popcorn and head on over to the CMSHHS channel on YouTube to preview the RAC 101 video featuring Connie Leonard and Commander Marie Casey, both of the Recovery Audit Contractor Program.  It's sure to entertain and inform.

It also must be YouTube's best-kept secret, because as of April 13 there had been only 629 views!

About the Author

Nancy Beckley is a co-founder and president of Bloomingdale Consulting Group, Inc., providing consulting services to the rehab professional. Nancy is certified in healthcare compliance by the Healthcare Compliance Board, and serves on the Part A and Part B Provider Outreach Education and Advisory Panel for First Coast Services Options (Florida Medicare). She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities.

Contact the Author

nancy@bloomingdaleconsulting.com

Nancy J. Beckley, MB, MBA, CHC

Nancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practices. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Mondays, where she serves as a senior national correspondent.

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