<img src="//bat.bing.com/action/0?ti=5565311&amp;Ver=2" height="0" width="0" style="display:none; visibility: hidden;">

Delta Connect Blog

Providers get brief respite from RAC ADRs with pause in operations

Posted by Crystal Parks on Feb 21, 2014 8:07:34 AM


Starting Feb. 21, you will get a break from additional documentation requests (ADRs) from recovery auditors (RACs), but it's temporary so "don't get too comfortable," advises Robert Markette, attorney with Hall, Render, Killian, Heath & Lyman in Indianapolis.

The Medicare bounty hunters will take "a pause in operations" to allow CMS to "refine and improve" the RAC program. That's a good thing for providers, says William Maruca, attorney at Fox Rothschild in Pittsburgh.

The pause lets the current RACs "complete outstanding claims reviews" before CMS awards the next round of RAC contracts, CMS says. For example, the backlog of all cases at the administrative law judge (ALJ) or third level of appeal is about 460,000, Markette notes.

In the meantime, CMS provides these additional key dates for providers:

  • Feb. 28: the last day a Medicare administrative contractor (MAC) can send pre-payment ADRs for the RAC pre-payment review demonstration.
  • June 1: the last day RACs can send improper payment files to the MACs for adjustment.

In the new contracts, which CMS is in the process of procuring, Medicare requires RACs to make five changes: wait 30 days before sending claims to MACs for adjudication; confirm they received discussion requests within three days; wait until the second level of appeal is exhausted before receiving their contingency fees; adhere to CMS' revised ADR limits that are diversified across claim types; and adjust the ADR limits in accordance with the provider's denial rate.

But Markette warns providers not to get too excited about the changes. Once the new contracts are awarded, "they'll just congratulate themselves on a job well done and go right back to doing it the way they always have," Markette expects.

CMS directs providers to email RAC@cms.hhs.gov with questions.

Roy Edroso (redroso@decisionhealth.com) and Laura Evans (levans@decisionhealth.com)

From Decision Health 


Topics: RAC Audits


Recent Delta Blogs