The New RAC | HDMS Featuring Sharon Briggman, of the SERT PGI LOGO*

Welcome HDMS Users

This presentation is intended to be your source for everything related to the renewed

RAC Audit Program!

Sharon Briggman from the Prometheus Group will give us the scoop on:

• Program changes

• Provider Portal tips

Lisa Anderson will be providing some RAC Management tricks in HDMS at the end!

About the Speaker

Sharon brings over 28 years of experience in the health insurance field including over 19 years of Medicare contractor experience in all areas of provider education and training. Prior to Prometheus, Sharon worked for Palmetto GBA in the capacity of Senior Ombudsman under Part A Home Health & Hospice and Part B Durable Medical Equipment (DME). In her capacity as an Ombudsman, Sharon worked to resolve and educate providers on critical issues referred by the anti-fraud unit, various internal departments, and congressional offices, including working with Federal prosecutors on fraud cases as an expert witness.

Sharon serves as a member of the Region D DAC Committee, DME MACs Region C and D POE AG and Jurisdiction C Council. She also speaks regularly at National Industry Conferences in addition to Software User Conferences.

Additional industry experience includes Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) currently a managed care system and renamed TRICARE, Blue Cross Blue Shield Major Medical and Medicaid. Sharon earned a bachelor’s degree in Psychology from North Carolina Central University (NCCU).

Welcome to today’s webinar- Be on the look out! RAC Audits are Back! For years now, the concept of the RAC for DMEPOS has caused several of you

as DME providers to lose sleep. The RACs began as a demonstration beginning from 2005-2008, as a model to regulate improper payments, to say the

least, the demonstration was very successful and was fully adopted by CMS in 2010. At that time, the original RACs were:

Diversified Collection (Region A)

GCI (Region B)

Connolly (Region C) AND

HealthData Insights (Region D)

A Closer Look at the Discussion Period

The Discussion Period request form is posted on the Performant Recovery website.

Fill out the form and include the reason that you would like to discuss the case.

There must be one Discussion form submitted per claim (no bundling claims on one form due to scanning processes).

Attach supporting documentation for reconsideration.

Indicate on the form if a physician-to-physician review is requested. If so, you will receive a call from the Discussion team to schedule the conference. Mail or fax the form to Performant.

Acknowledgment of the Discussion request occurs when the form is scanned into the Performant system.

This acknowledgement is viewable via your provider portal login.

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Audit Review

May return medical record requests via:

Mail: Paper or CD/DVD Documentation should be mailed to:

Performant Recovery, Inc. Records department

2751 Southwest Boulevard

San Angelo, TX 76904

If mailing documents, it is strongly recommended all medical records be sent to via a traceable carrier such as FedEx, UPS, DHL, registered USPS mail, in a tamper-proof, padded package.

Fax: 325.224.6710

electronic submission of Medical Records (esMD) Please contact Performant if you are able to send medical records via esMD to make arrangements.

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Issue Details

Portal Information

The provider's overall ADR limit

ADR letter mailed date

Medical documentation received date

Medical review completed date

The outcome of the review (overpayment, underpayment, no finding)

Discussion period information Appeals outcomes

Case closure date

Update Contact Info

Note: The portal is updated nightly!

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Coping with RAC Audits in HDMS

Collection & Denial Management can keep track of your RAC Audits for you!

• Mark a claim requested for RAC Audit with a special status code

• Use Templates to create a Worksheet to work those claims as often as you want!

• Change the status code and set for follow up to keep track of discussion time periods

Tracking RAC Requests in HDMS

In Claim Maintenance:

Mark your requests with a status like

“RAC request received”

and enter

Follow Up Date: Today’s date

as soon as you receive them!

Tracking RAC Requests in HDMS

In Worksheet Admin:

Create a Template for

“RAC Audits TO DO”

and let HDMS create a Worksheet for you based on

the Status Code!

You will never forget a request again!

Tracking Submitted RAC Requests

In Worksheet Admin:

Create an additional template based on follow up date and your

secondary RAC Status Code.

HDMS will automatically remember those claims

for you!

Thank you for joining us!

Want to set up

Collections & Denial

Management to handle

your RAC Audits?

Contact:

Lisa Anderson

lisaa@universalss.com

(248) 450-0877 x 334

We love Sharon!

Contact:

Sharon Briggman

sharonb@prometheusteam.com

770-510-8949

or

Amy Lawson

amyl@prometheusteam.com

980-201-3081

Important Reminder Regarding the ABN!

The ABN, Form CMS R131 has been updated! The effective date for use of this ABN form is 6/21/2017. Providers should take note of the newly incorporated expiration date on the form (Exp. 03/2020).

Background:

March 2017: The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. While there are no changes to the form itself, providers should take note of the newly incorporated expiration date on the form (Exp. 03/2020).

In accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), the form has been revised to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed.

Important Tips! Submitting Medical Records

Requested documentation may be submitted via:

esMD

Postal Mail Either images on CD/DVD or on paper

Electronic Submission of Medical Documentation (esMD)

Performant preferred method

The esMD system allows providers and HIHs to electronically send their responses to Additional Documentation Request (ADR) letters to review contractors during the claims review process.

One of the benefits of using esMD is that it can help mitigate late submissions and potential technical denials.

Performant cannot recommend a HIH, however there are several HIH's available to offer esMD gateway services to Providers.

More information is available at this CMS.gov link. It includes list of HIH vendors and how to contact them.

Important Tips! Submitting Medical Records

Medical Record Submission via CD/DVD or Paper:

If submitting via paper or CD/DVD a copy of the Bar Code Sheet(s) must be affixed to the requested documentation.

Bundle documents for each claim separately to enable us to confirm receipt of documents.

Important Tips! Submitting Medical Records

Medical Record Submission

1. In the example to the right there are

3 distinct record requests.

Copy the Bar Code Sheet(s) as the first

page for each corresponding set of

documents.

2. Place a check mark where indicated

to associate the claim # with the

corresponding set of documents (the

records for each claim should be a

separate and distinct bundle).

3. Documentation submitted without

the barcode identifier will be

rejected.

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Important Tips! Submitting Medical Records

Include a copy of the Bar Code Sheet(s) with CD/DVD package

Multiple charts can be sent on one CD/DVD but each chart request must be a separate PDF/TIFF file and named appropriately.

Naming Convention for each claim submitted is: NPI#-Claim# Example:

Claim number is 123456

NPI is 654321

File name is 654321-123456

Scanned image resolution must be clear & legible - 300 dpi and in black and white Image format must be in either PDF or TIFF format (PDF is preferred )

For PDF format, DO NOT password protect the INDIVIDUAL PDF files.

Instead, zip all PDFs into a WinZip file and encrypt it.

CD/DVDs do not require encryption but it is recommended for security purposes. If encryption/password protection is desired, the following common WinZip options are accepted:

Zip 2.0 compatible encryption

256-Bit AES encryption

If a password is required to open a zipped CD/DVD please submit that password to Performant Recovery, prior to shipment, via the method below.

E-mail password to: info@performantRAC.com

Email must include letter request id and claim number for identification.

mailto:info@performantRAC.com

Important Tips! Submitting Medical Records

Medical Record Submission via Paper: Include a copy of the Bar Code Request Sheet(s)

Use standard 8 ½ x 11 paper

3 hole punched paper will NOT be accepted

No staples or staples holes

Each chart should be individually secured with a rubber band or paper clip

Photocopy must be of good quality and legible

Records must be copied on only one side

Pages should be top faced and face up

Example: Bar Code Request Sheet