1 / 16

Medicare RAC Program Update: Current Status & Key Information

Learn about the current status of the Medicare RAC Program, how claims are selected for review, where new issues are posted, and how to access contact information for the RACs and CMS. Stay informed to avoid compliance issues.

thelma
Download Presentation

Medicare RAC Program Update: Current Status & Key Information

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CDR Marie CaseyScott Wakefield RAC Program Update

  2. The RAC Program Mission • The RACs detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments • Providers can avoid submitting claims that do not comply with Medicare rules • CMS can lower its error rate • Taxpayers and future Medicare beneficiaries are protected

  3. RAC Legislation • Medicare Modernization Act, Section 306 • Required the 3-year RAC demonstration • Tax Relief and Healthcare Act of 2006, Section 302 • Requires a permanent and nationwide RAC program by January 1, 2010 • Both of these statutes gave CMS the authority to pay the RACs on a contingency fee basis

  4. D A B C RAC Regions

  5. What is the Current Status of the Permanent RAC Program? • Provider outreach has occurred in every state • All RACs have Medicare claims data • All states are eligible for review • All RACs have posted new issues on their website • Mass adjustment process implemented July 2010

  6. What is the Current Status of the Permanent RAC Program? • Release of several education articles (MLN and Quarterly newsletter) based on RAC identified vulnerabilities • Post Quarterly RAC Data beginning in 2011 • Demanded, Underpayment, Collected Amounts • Top 3 reasons for Additional Documentation Requests (ADRs) • Number of ADRs requested • Publish Annual Report to Congress

  7. How do RACs Select Claims for Review?

  8. CMS RAC Review Strategy • DRG Validation- complex review (fall 2009) • Complex Review for coding errors (fall 2009) • Automated Review- Black & White Issues (early 2009) • DME Medical Necessity Reviews – complex review (calendar year 2010) • Medical Necessity Reviews-complex review (calendar year 2010)

  9. Where are New Issues Posted? • Region A: Diversified Collection Services (DCS) • www.dcsrac.com (Provider Portal/Issues Under Review) • Region B: CGI Federal • http://racb.cgi.com (Issues) • Region C: Connolly Healthcare • www.connollyhealthcare.com/RAC (Approved Issues) • Region D: HealthDataInsights (HDI) • https://racinfo.healthdatainsights.com (New Issues)

  10. Sample New Issues • Pharmacy Supply and Dispensing Fees • Wheelchair Bundling • Urological Bundling • Blood Transfusions • IV-Hydration • Neulasta (Pegfilgrastim) • Once in a Lifetime Procedures • Untimed Codes • Clinical Social Worker (CSW) Services • DRG Validation (various)

  11. Example New Issue Posting Issue Name: Wheelchair Bundling Description: Bundling guidelines for wheelchair bases and options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable. Provider Type Affected:    DME Date of Service: 10/01/2007 - Open

  12. Example New Issue Posting States Affected: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia Additional Information: Additional information can be found in the following manuals/publications: http://www.cms.hhs.gov/mcd/viewarticle_pdf.asp?article_id=20284&article_version=32&contractor_id=140

  13. Major Findings – Closing the Loop • RACs post major findings to their websites • CMS publishes information on RAC major findings in the Annual Report to Congress • RACs share vulnerabilities internally and with all Medicare Contractors who will implement appropriate corrective actions

  14. RAC ContactInformation • Region A: Diversified Collection Services (DCS) • www.dcsrac.com • info@dcsrac.com • Region B: CGI Federal • http://racb.cgi.com • racb@cgi.com • Region C: Connolly Healthcare • www.connollyhealthcare.com/RAC • RACinfo@connollyhealthcare.com • Region D: HealthDataInsights (HDI) • https://racinfo.healthdatainsights.com • racinfo@emailhdi.com

  15. CMS Contact Information • CMS RAC Website: www.cms.gov/RAC • CMS RAC Email: RAC@cms.hhs.gov

  16. Thank you for inviting us!

More Related