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Recovery Asset Contractor Survey Poll

19 Responses

1. Mike, on December 1, 2009 at 1:05 PM said:

   Like RACs?

   Much like the RACs, the Medicare Integrity Program [MIP] allows the Department of Health and Human Services [DHHS] to contract with non-governmental organizations, known as Medicare Program Safeguard Contractors [MPSC] to carry out fraud and abuse detection, cost report audits, utilization review, provider payment determinations, and provider education, and to create a list of durable medical equipment subject to prior authorization for reimbursement.

   Under this program, the Centers for Medicare and Medicaid Services (CMS) must implement regulations for contracting procedures.

   Mike

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2. Ann, on April 15, 2010 at 9:59 AM said:

   Medicare Payment Audits Criticized in GAO report

   As the Obama administration works to expand the scope of recovery audit contractors to seek out improper Medicare payments, a new government oversight report concludes that Medicare must do a better job of addressing the vulnerabilities that the RACs identify.

   A March report from the Government Accountability Office said the Centers for Medicare & Medicaid Services did not establish an adequate process to address payment system problems uncovered by the contractors either during the three-year initial pilot program of the RACs or in planning for the rollout of a permanent, nationwide version of the program. The RACs comb through past Medicare claims from hospitals, physicians and others to identify instances in which the government paid too much or inappropriately approved claims.

   Source: Chris Silva, AMNews [4/12/10]

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3. Betty, on June 23, 2010 at 8:43 PM said:

   Preparing for the RAC Incursions

   At a recent ANI session, Marina McDonough, revenue cycle consultant for CareMedic Systems, and Gerilynn Sevnikar, vice president of patient financial services for Sharp HealthCare, offered some basic advice for hospitals to prepare for a RAC incursion:

   1. Assess the hospital’s exposure for RAC denials to determine how much money should be reserved from an accounting perspective.

   2. Create a multidisciplinary team that includes financial, clinical, IT, and operational staff. The facility’s RAC coordinator should lead–and work directly with–the RAC committee to ensure information flows through the entire organization.

   3. Capture data in multiple formats in order to get the clearest picture of the hospital’s exposure risk, and set up a dashboard to monitor the areas at higher risk.

   4. Educate clinical and nonclinical staff to institute changes that prevent RAC take-backs on a go-forward basis.

   Betty

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4. Mike, on July 17, 2010 at 9:40 PM said:

   Expanding RAC will be a Stretch: Official

   The CMS faces some challenges ahead in expanding the Recovery Audit Contractor program to all of Medicare and to Medicaid by the end of the year, an agency representative told a Senate panel. The RAC program allows third-party auditors hired by the CMS to keep 9% to 12.5% of provider payments they identify as improper. Currently, it conducts audits only in fee-for-service Medicare, but provisions in the new reform law call for an expansion of the RAC program to Medicare Parts C and D and Medicaid by Dec. 31.

   Such a task will not be easy, admitted Deborah Taylor, director and chief financial officer of the CMS’ Office of Financial Management, who testified before the Senate Homeland Security and Governmental Affairs’ Subcommittee on Federal Financial Management, Government Information, Federal Services and International Security. Phasing in RAC audits for Medicare Advantage “is going to be tougher for us,” given that the CMS already has a contractor that gets paid to conduct audits for Medicare Part C, she said. “We don’t want to duplicate our efforts.”

   Source: Jennifer Lubell, Modern Healthcare [7/15/10]

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5. Conrad, on October 7, 2010 at 7:13 PM said:

   New CMS Guidelines for RACs

   The Centers for Medicare & Medicaid Services has begun providing more succinct communications regarding its recovery audit contractor programs (RAC news).

   • http://www.fiercehealthfinance.com/story/cms-issues-new-rac-communications/2010-10-05?utm_medium=nl&utm_source=internal
   • http://www.cms.gov/smdl/smd/itemdetail.asp?itemid=CMS1239966

   Conrad

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6. Ann Miller RN MHA, on October 14, 2010 at 1:28 PM said:

   Beyond RACs: ZPICs, MICs, & MACs

   In the years since the Tax Relief and Healthcare Act of 2006 much attention has been paid to Medicare and Medicaid fraud and abuse. This Act increased enforcement against fraudulent and unnecessary claims for services under the Centers for Medicare and Medicaid Services. The Act also called for an overhaul of CMS claims payment contractors with the implementation of Recovery Audit Contractors (RACs).

   But, while RACs have garnered significant attention in this area, Zone Program Integrity Contractors (ZPICs), Medicare Administrative Contractor (MAC), and Audit Medicaid Integrity Contractors (Audit MICs) have gained prominence in recent years and may become more prevalent in the new stages of the current healthcare reform.

   Click to access zpic.pdf

   And so, your thoughts are appreciated.

   Source: Health Capital Consultants, LLC
   [St. Louis, MO]

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7. Bill, on December 21, 2010 at 3:26 PM said:

   Medicare Auditors Probing Deeper into Medical Decision-Making

   Complex reviews are getting a whole lot more complex, as some Medicare reviewers reportedly wade deeper into medical decision-making. DRG validations and medical-necessity audits are being performed at a level never seen before, several experts say. Some recovery audit contractors, RAC-like auditors, Medicare administrative contractors (MACs) and Medicare quality improvement organizations (QIOs) are denying claims because they disagree with the physician’s conclusions about a patient’s condition or the need for a procedure. In some cases, claims are being denied because the physician didn’t base the diagnosis on clinical guidelines, even when their use is not required by Medicare, sources tell RMC.

   “In the past, auditors focused on whether charts contained physician orders, and whether they were signed and dated and specific to the services delivered,” says Kevin Cornish, national director of the healthcare dispute, compliance and investigation practice for Navigant Consulting. “Now it’s what was the diagnosis, what was the history, what tests were run, what decisions were made in terms of the procedures performed, and was it consistent with Medicare requirements?’”

   Source: Nina Youngstrom, Report on Medicare Compliance [12/20/10]

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8. Hope R. Hetico RN MHA, on April 29, 2011 at 10:18 AM said:

   HHS Proposes ‘Mystery Shoppers’ for Docs

   HHS is proposing to use a “mystery shopper” program to gauge primary-care physicians’ timeliness in accepting new patients, according to a notice in today’s Federal Register.

   The plan calls for contacting 4,185 primary-care physicians—465 in each of nine as-yet-unnamed states—twice, once by someone pretending to be a new patient who has private insurance and once by someone pretending to be a publicly insured patient. Scenarios will involve patients with both urgent medical concerns and those requesting a routine medical exam.

   The purpose of this program, according to the Federal Register item, is to assess the timeliness with which primary-care services could be provided, gain insight into reasons why availability is lacking, and provide current information on primary-care availability and accessibility.

   Source: Andis Robeznieks, Modern Physician [4/28/11]

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9. Hope R. Hetico RN MHA, on June 23, 2011 at 5:05 PM said:

   CMS Taps Northrup Grumman for Anti-fraud Project

   Anyone familiar with the predictive-modeling techniques that allow credit card companies to detect suspicious charges at the cash register might wonder why the CMS couldn’t do the same thing with all the blatantly fraudulent charges sent to Medicare.

   Officials say the federal Medicare payer has just inked a $77 million contract to do exactly that, hiring defense contractor Northrup Grumman under a multi-year deal to develop rapid predictive-modeling methods that can analyze claims for federal payments before the bills are paid. The CMS in March implemented new final regulations, based on new enforcement techniques authorized in the Patient Protection and Affordable Care Act, that will allow the agency to withhold payments on Medicare claims when authorities have a credible allegation of fraud.

   Source: Joe Carlson, modernhealthcare.com [6/17/11]

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10. Jeff, on August 5, 2011 at 5:52 AM said:

    RAC Program Collects $233 Million Dollars

    The CMS’ Medicare fee-for-service recovery audit contractor program collected about $233.4 million in overpayments from March through June of this year, bringing the total of recouped overpayments since October 2009 to about $575.2 million. A permanent national program since last year, the RAC program uses four contractors—Diversified Collection Services, CGI, Connolly, and HealthDataInsights—to help identify fraud and abuse.

    Meanwhile, the RAC program returned about $55.9 million in underpayments to providers for the third quarter, which is more than double the $23.7 million in underpayments it returned in the previous quarter. Since October 2009, the RAC program has returned about $109.6 million in underpayments.

    Source: Jessica Zigmond – Modern Healthcare [8/3/11]

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11. Hope R. Hetico RN MHA CMP™, on November 30, 2011 at 11:54 AM said:

    Medicare RACs to Conduct Pre-payment Reviews for Doctors and Hospitals

    Medicare contractors will begin pre-payment reviews of certain Medicare claims starting in January 2012 in an effort to reduce the estimated billions in improper federal healthcare payments made each year. Physician and hospital organizations reacted warily to the announcement. Although they said doctors and hospitals understand the need to limit errors and fraud in healthcare claims, the reviews could add yet another administrative burden.

    The first of the three-year demonstration programs — all beginning in January 2012 — will allow Medicare recovery audit contractors to conduct prepayment reviews of certain claims in 11 states. RACs currently examine claims after they have been paid.

    Source: Doug Trapp, AMNews [11/28/11]

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12. Ann Miller RN MHA, on August 8, 2012 at 9:42 AM said:

    New CMS Rules Cut ‘Red Tape’ – Will Save Money

    The CMS issued new financial transaction rules for hospitals and other HIPAA-covered providers Tuesday that federal officials expect will cost up to $2.7 billion over 10 years but save as much as $4.5 billion. The interim final rule, with which providers must comply by Jan. 1, 2014, will establish new operating standards both for electronic fund transfers in healthcare and for describing adjustments to claim payments.

    The rule requires insurers to offer a standardized, online enrollment for EFT and electronic remittance advice, or ERA, to encourage more providers to enroll and receive electronic payments from multiple health plans. The rule also requires health plans to send the EFT within a certain number of days of the ERA, to help providers reconcile their accounts more quickly.

    Source: Rich Daly, Modern Physician [8/7/12]

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13. Hope R. Hetico RN MHA, on February 20, 2013 at 4:11 AM said:

    Government gets healthy return on fraud recovery

    The federal government recovered $4.2 billion in healthcare fraud judgments, settlements and other proceedings during 2012, the Departments of Justice and Health & Human Services reported last week.

    http://www.physbiztech.com/news/feds-get-healthy-return-fraud-recovery?email=MARCINKOADVISORS%40MSN.COM&GroupID=90115

    According to the report, the return on investment for the recovery program over the last three years is $7.90 for every $1 spent.

    Hope R. Hetico RN MHA

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14. Ann Miller RN MHA, on May 17, 2013 at 9:19 AM said:

    AOPA Files Suit Against HHS Over RACs and Physician Documentation Requirements

    On May 13th, the American Orthotic & Prosthetic Association (AOPA) filed suit against HHS in the Federal District Court for the District of Columbia. The complaint seeks relief from the unfair and unauthorized actions of the Center for Medicare and Medicaid Services, primarily via actions of its RAC auditors and DME MACs relating to physician documentation requirements.

    AOPA has stated emphatically that they will not stand by when government acts inappropriately to threaten either the quality of care we provide to patients or the economic viability of the small businesses and providers that comprise the orthotics and prosthetics profession.

    Source: AOPA

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15. Ann Miller RN MHA, on May 25, 2014 at 6:25 PM said:

    Hospitals Sue HHS Over Sluggish RAC Appeals

    Administrators at Baxter Regional Hospital in Mountain Home, AR say they have so much money tied up in endless Medicare appeals that they can’t afford to replace the roof over their surgery department or buy new beds for their intensive-care unit. Baxter joined two other hospital-care providers and the American Hospital Association on Thursday in a federal lawsuit against HHS asking a judge to force the agency to meet its statutory requirement to decide Medicare-payment appeals within 90 days instead of the current average of 16 months.

    Some hospitals could wait up to five years to get decisions on routine payments because of a massive backlog in the appeals process that has been created by the aggressive post-payment review program known as recovery auditing. That’s due in part to HHS’ administrative law judges announcing a two-year moratorium on docketing new Medicare appeals for hospitals.

    Source: Joe Carlson, Modern Healthcare [5/23/14]

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16. Susan, on September 4, 2014 at 5:52 PM said:

    Reversing Medicare’s Downward Spiral by Reining in the RACs

    RAC contractors have caused a “torrent of problems that harm both hospitals and patients,” says AHA President and CEO Rich Umbdenstock.

    http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2014/Sep/090414-umbdenstock-RACs&utm_source=daily&utm_medium=email&utm_campaign=HHN

    It’s time to advance Medicare auditing programs that are fair and rational. OR, are RACs really wrecks?

    Susan

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17. Kent, on September 26, 2014 at 10:43 AM said:

    CMS offers a RAC truce

    Amid a massive backlog of hospital inpatient claims appeals at the Office of Medicare Hearings and Appeals, the Centers for Medicare & Medicaid Services is giving providers the chance to settle up?

    http://www.healthcarefinancenews.com/news/cms-offers-rac-truce?mkt_tok=3RkMMJWWfF9wsRonvqzBZKXonjHpfsX56O0kXK6zlMI%2F0ER3fOvrPUfGjI4AT8piI%2BSLDwEYGJlv6SgFQ7LHMbpszbgPUhM%3D

    And, get paid – at least in large part.

    Kent

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18. Tim, on November 16, 2014 at 4:52 PM said:

    2 Ways to Avoid a RAC Audit

    Small and medium-sized practices are not below the RAC radar and should heed the following succinct steps to avoid and/or minimize exposure.

    1. Avoid copy-and-paste documentation — While it is acceptable to use templates, your documentation must be patient-specific. The RACs have been chastised by the Office of Inspector General (OIG) for not giving this issue enough attention; expect greater scrutiny in 2015 and beyond. Boiler plate wording may be your starting point, but it only passes muster when made patient-specific.

    2. Know where you stand on E&M coding — Physicians who over-code evaluation and management services (E&M) relative to their peers remain at a greater risk of audit. Compare your E&M coding averages to a national benchmark. The American Association of Professional Coders (AAPC) offers an easy and free way to get national E&M coding averages by specialty.

    Source: Lucien Roberts, III, Physician’s Practice [11/12/14]

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19. Ann Miller RN MHA, on December 30, 2015 at 3:40 PM said:

    CMS to Launch RACs for Medicare

    During a time of growing interest in covering Medicare members, the CMS is looking to vastly expand audits of Medicare Advantage plans as a way to monitor insurers that may game the system to obtain higher payments.

    Last week, the CMS released a request for information that outlined the expansion of Medicare’s Recovery Audit Program, a program that has drawn the scorn of hospitals and doctors. In that program, the government hires private companies called recovery audit contractors, or RACs, to comb through medical records at hospitals and doctor offices and find instances of where Medicare is paying too much money.

    Providers have characterized RACs as administrative burdens and argued that auditors have clear incentives to hunt for overpayments even when they may not exist. RACs are paid an amount that is contingent on how much money they recover for the government. Those same complaints are likely to extend to Medicare insurers, which, if found to have improperly billed, could have to forfeit millions of dollars back to Medicare. But the CMS touts RACs as a way to ensure that taxpayer money is being spent appropriately.

    Source: Bob Herman, Modern Healthcare [12/28/15]

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