1 / 13

Recovery Audit Contractor (RAC) Program Review and Update

Recovery Audit Contractor (RAC) Program Review and Update. Narcessa Chesil Project Officer, RAC Region C Division of Recovery Audit Operations Centers for Medicare & Medicaid Services. What is the Current Status of the Permanent RAC Program?.

madeson-pickett
Download Presentation

Recovery Audit Contractor (RAC) Program Review and Update

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. Recovery Audit Contractor (RAC)Program Review and Update Narcessa Chesil Project Officer, RAC Region C Division of Recovery Audit Operations Centers for Medicare & Medicaid Services

  2. What is the Current Status of the Permanent RAC Program? • The Tax Relief and Health Care Act of 2006, Section 302, required a permanent and nationwide RAC program by January 1, 2010 • Provider outreach has occurred in every state • All RACs have data • All states are now eligible for review

  3. FY 2009 Outreach Presentations Circle = State Outreach Sessions Square = National Presentations Triangle = Local Presentations (Green = Regional)

  4. CMS RAC Review Phase-in Strategyas of 06/24/09 Earliest possible dates for reviews in yellow/green states Earliest possible dates for reviews in blue states • Automated Review- Black & White Issues (June 2009) • DRG Validation- complex review (Aug/Sep 2009) • Complex Review for coding errors (Aug/Sep 2009) • DME Medical Necessity Reviews – complex review (Fiscal year 2010) • Medical Necessity Reviews-complex review (Calendar year 2010) • Automated Review- Black & White Issues (August 2009) • DRG Validation- complex review (Oct/Nov 2009) • Complex Review for coding errors (Oct/Nov 2009) • DME Medical Necessity Reviews – complex review (Fiscal year 2010) • Medical Necessity Reviews-complex review (Calendar year 2010)

  5. 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)

  6. Some New Issues Pharmacy Supply and Dispensing Fees Wheelchair Bundling Urological Bundling Blood Transfusions Bronchoscopy Services IV-Hydration Neulasta (Pegfilgrastim) Once in a Lifetime Procedures Untimed Codes Clinical Social Worker (CSW) Services Knee Orthotic Bundling

  7. Example of A 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 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

  8. What about Rebilling? • Providers can re-bill for Inpatient Part B services, also known as ancillary services, but only for the services listed in the Benefit Policy Manual. That list can be found at: http://www.cms.hhs.gov/manuals/Downloads/bp102c06.pdf • Rebilling for any service will only be allowed if all claims processing and timeliness rules are met. The normal timely filing rules can be found at: http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf

  9. Appeal When Necessary • The appeals process for RAC denials is the same as the appeals process for Carrier/FI/MAC denials • Do not confuse the “RAC Discussion Period” with the appeals process • Appeals data from demonstration and going forward

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

  11. Questions?

  12. Questions: • Q. Please clarify the reason for discussion period and how the provider should include this in their process? • A. The RAC Auditors contact information will be on each demand letter and the provider would call them for discussion if there was clearly an error in the take back demand. • Q. Will interest begin at day 30 or day 41 from the date of the demand letter? • A. Interest will begin on day 30 • Q. What process does the provider use to rebill Part B Ancillary services following the denial of a Part A claim. • A. See Slide 8 – Remember : Provider cannot rebill until claim adjustment is made or I/P claim is paid back. 12

  13. Questions: • Q. Does CMS anticipate starting the complex reviews earlier than January 2010? • A. No • Q. Will CAH's be reimbursed for copying cost differently than PPS hospitals? • A. Yes, CAH’s will be reimbursed on their cost report. Copy cost is an allowable Medicare cost at .12 per copy. PPS hospitals will be reimbursed monthly. • Q. Can you confirm that all deductables and copays must be returned to the patient on claims identified for takeback? • A. Yes, the beneficiary will be notified after the claim has been recouped. 13

More Related