1 / 12

Medicare Recovery Audit Contractors (RACs)

Medicare Recovery Audit Contractors (RACs). Connie Leonard, Director, Division of Recovery Audit Operations Melanie Combs-Dyer, CMS RAC Senior Technical Advisor. 1. Background: IPIA. Improper Payment Information Act requires federal agencies to measure improper payment rates

scallis
Download Presentation

Medicare Recovery Audit Contractors (RACs)

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. MedicareRecovery Audit Contractors (RACs) Connie Leonard, Director, Division of Recovery Audit Operations Melanie Combs-Dyer, CMS RAC Senior Technical Advisor 1

  2. Background: IPIA • Improper Payment Information Act requires federal agencies to measure improper payment rates • “Improper payments” include • overpayments • underpayments 2

  3. RAC Legislation • Medicare Modernization Act Section 306: required RAC demonstration • Tax Relief Act and Healthcare of 2006, Section 302: requires permanent and nationwide RAC program by no later than 2010 • Both statutes gave CMS the authority to pay RACs on a contingency fee basis. 3

  4. RAC Program Mission… • to detect and correct past improper payments, • to implement actions that will preventfuture improper payments. • Providers can avoid submitting claims that don’t comply with Medicare rules • CMS can lower its error rate • Taxpayers & future Medicare beneficiaries are protected 4

  5. Results of the RAC DemonstrationCollections exceeded costs Report now available at www.cms.hhs.gov/RAC 3/27/05-3/27/08 (Claim RACs & MSP RACs) 5

  6. Results of the RAC DemonstrationAppeals were minimal Cumulative through 3/27/2008 6

  7. Results of the RAC DemonstrationRACs affected a very small percentage of all Medicare Payments $1.0 billion $316 billion Medicare Payments corrected by the RACs Medicare Payments Unaffected by RACs 0.3% 99.7% 3/27/05-3/27/08 (Claim RACs & MSP RACs) 7

  8. Results of the RAC DemonstrationMost overpayments were collected from inpatient hospitals 6% IRF, $59.7m 85% Inpatient Hospital, $828.3 m 2% Skilled Nursing, $16.3m 4% Outpt. Hospital, $44.0m 1% Durable Med Equip, $6.3m 2% Physician, $19.9m <1% Ambulance/Lab/Other, $5.4m 8 SOURCE: RAC Data Warehouse

  9. Lessons Learned Concern: RACs had a significant financial impact on some providers • Change: • Limit the number of medical record requests • Limit the RAC “look-back period” • Concern: RACs were not required to hire physicians and certified coders • Change: • CMS has required each RAC to hire a physician medical director • CMS has required each RAC to hire certified coders • Concern: Some providers questioned the accuracy of RAC reviews • Change: • New issue review board (greater oversight) • Independent validation contractor • Annual accuracy rates for each RAC • Concern: The RAC program was not transparent enough • Change: • New issues posted to web • Vulnerabilities posted to web • RAC claim status website 9

  10. RAC Expansion Schedule A D B Oct. 1, 2008 March 1, 2009 Aug. 1, 2009 or later C

  11. Key Website & Contact Information www.cms.hhs.gov/RAC RAC@cms.hhs.gov 11

  12. Provider Feedback Questions • How would you (providers) like to learn about the Recovery Audit Contractor program? What is the best vehicle for reaching and providing outreach to providers? • How would you (providers) like to learn about vulnerabilities identified by a Recovery Audit Contractor? What format will help you in your practice or facility? (These are vulnerabilities that have been identified in a large scale. These are not specific findings for a single facility. Specific findings will be communicated through written correspondence.) • All Recovery Audit Contractors will develop a web-based tracking system to allow providers to track claims requested by a RAC. What information should the RACs include in this system? Please keep in mind that Personal Health Information (PHI) cannot be included.

More Related