RAC program scheduled for full implementation in 2010
Changes will alleviate some administrative headaches
The Recovery Audit Contractor (RAC) demonstration program began in March 2005 and ran until March 2008. The RAC program will be a permanent program and expand nationwide no later than Jan. 1, 2010.
The Centers for Medicare and Medicaid Services (CMS) expects to meet the following timeline:
- Dec. 1, 2007, was the last day a demonstration RAC could issue medical record request letters.
- Feb. 1, 2008, was the last day a demonstration RAC could issue Part B demand letters.
- Feb. 15, 2008, was the last day a demonstration RAC could issue Part A informational letters.
- In the spring of 2008, CMS will announce the names of the companies chosen to be the permanent RACs for the four regions.
- In the spring/summer of 2008, CMS and the new RACs will conduct provider outreach. CMS will work with provider associations to help facilitate outreach.
Based on feedback from RACs and providers, CMS has made the following improvements to the RAC program:
- The look back period has been changed from four years to three years in the permanent program.
- In the demonstration project, CMS did not give a maximum look back date. In the permanent program, the RACs will not be able to look for any improper payments on claims paid before Oct. 1, 2007.
- In the demonstration, RACs were not allowed to review claims during the current fiscal year, but they will be allowed to review claims during the current fiscal year in the permanent program.
- Certified coders were not mandatory in the demonstration. In the permanent program, each RAC must have certified coders.
- There was an optional medical record limit set by the individual RAC in the demonstration. The permanent program will have mandatory limits set by CMS.
- During the demonstration, discussion with the medical director regarding claim denials if requested by providers was optional. In the permanent program, it is mandatory.
- The demonstration called for limited reporting by the RACs on the problem areas they had identified. Frequent problem area reporting is mandatory in the permanent program.
- During the demonstration, the RACs only had to pay back the contingency fee if they lost at the first level of appeal. This has been changed to all levels of appeal for the permanent program.
- The RACs did not offer a web-based application that allows providers to customize addresses and contact information or see the status of cases during the demonstration. In the permanent program, each RAC must have this web-based application by Jan. 1, 2010.
- During the demonstration, an external validation process was optional and it varied by state. The external validation process is mandatory for the permanent program and it is a uniform process.
Reference
1. CMS RAC Status Document FY 2007. Status Report on the Use of Recovery Audit Contractors (RACs) In the Medicare Program. Centers for Medicare and Medicaid Services, February 2008.
The Recovery Audit Contractor (RAC) demonstration program began in March 2005 and ran until March 2008. The RAC program will be a permanent program and expand nationwide no later than Jan. 1, 2010.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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