CMS Announces 5 Changes to RAC Program, Halts Documentation Requests

CMS has announced it will "pause" additional documentation requests from Medicare recovery audit contractors as the agency procures the next round of RAC contracts.

The pause in operations will allow auditors to complete all outstanding claims reviews and other processes before the current contracts expire, as well as allowing CMS to refine and improve the RAC program.

Feb. 21 will be the last day RACs can send a post-payment additional documentation request. Additionally, Feb. 28 will be the last day Medicare administrative contractors can send additional documentation requests for the Recovery Auditor Prepayment Review Demonstration. Finally, June 1 is the last day RACs can send improper payment files to the MACs for adjustment. CMS has not yet specified when regular operations will resume.

CMS has also announced it's making five adjustments to the RAC program in response to industry feedback. These changes will take effect with the next RAC contract awards.

1. In response to concerns about provider appeals ending discussion periods, RACs will have to wait 30 days to allow for discussion before sending claims to MACs for adjustment. Providers will no longer have to choose between initiating a discussion and an appeal.

2. Industry members expressed concern that providers don't receive confirmation their discussion request has been received. Therefore, RACs will have to confirm receipt of a discussion request within three days.

3. RACs have been paid their contingency fee after recovering improper payments, even if providers decide to appeal the claims. With the next round of contracts, RACs must wait until the second level of appeal is exhausted before collecting their contingency fee.

4. Additional documentation request limits are currently based on the entire facility, without taking differences in department into account. Going forward, CMS is establishing revised additional documentation request limits diversified across different claim types (for example, inpatient and outpatient).

5. Additional documentation requests have been the same for providers of similar size and haven't been adjusted according to compliance with Medicare rules. For the next round of RAC contracts, CMS will require auditors to adjust the limits based on providers' denial rates so that those with low rates will have correspondingly low request limits.

More Articles on Medicare RACs:
OMHA Holds Forum on RAC Audit Appeals Backlog  
3 Key Articles on Medicare RACs
Coalition Asks HHS to Reform Medicare RAC Appeals Process 

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