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More Medicare RAC Details Unveiled
August 15, 2008
The Centers for Medicare and Medicaid Services will select four independent contractors to run the new national Medicare Recovery Audit Contractor program in September. The RAC program will be phased in state-by-state starting in the fall, says Melanie K. Combs-Dyer, a CMS senior technical advisor.
CMS concluded a demonstration project for the audit program earlier this year and announced plans to expand the program nationally based on the success of the pilot in recouping Medicare overpayments, primarily to hospitals. Under the program, independent auditors review claims, often requesting that providers submit detailed records to demonstrate that the billing was properly documented.
A number of consultants and other experts advise hospitals to begin preparing for the looming national audit program by conducting internal claims audits using data mining or claims analysis software. They also recommend using software to carefully track the status of all pending claims audits. A story in the October issue of Health Data Management will offer in-depth guidance on using I.T. to prepare.
For the new national RAC program, the four contractors will continue to send their requests for medical records via postal mail, Combs-Dyer acknowledges. Providers will be able to submit the records via postal mail, fax or mailed CD or DVD.
“CMS is exploring mechanisms that would allow providers to electronically upload imaged medical records to the RAC,” she adds. “On or before January 2010, each RAC will develop and implement a Web-based application that allows providers to see the status of each medical record request.”
In response to hospitals’ complaints during the RAC demonstration about being inundated by requests for records, CMS plans to establish a limit on the number of records that can be requested during each 45-day period. That limit will be posted on the CMS Web site,cms.hhs.gov/RAC, along with the state-by-state phase-in schedule.
In the new national program, Medicare claims from physicians as well as
hospitals will be subject to audits, Combs-Dyer stresses. “The RACS may choose
to review any claim that is likely to contain an improper payment,” she
adds.
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