Recovery Audit Contractor (RAC) Program Review and Update
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NARCESSA CHESIL PROJECT OFFICER, RAC REGION C DIVISION OF RECOVERY AUDIT OPERATIONS CENTERS FOR MEDICARE & MEDICAID SERVICES Recovery Audit Contractor Recovery Audit Contractor (RAC) (RAC) Program Review and Update Program Review and Update
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Recovery Audit Contractor (RAC) Program Review and Update. Narcessa Chesil Project Officer, RAC Region C Division of Recovery Audit Operations Centers for Medicare & Medicaid Services. What is the Current Status of the Permanent RAC Program?. - PowerPoint PPT Presentation
Transcript of Recovery Audit Contractor (RAC) Program Review and Update
NARCESSA CHESIL
PROJECT OFFICER, RAC REGION C DIVISION OF RECOVERY AUDIT OPERATIONS
CENTERS FOR MEDICARE & MEDICAID SERVICES
Recovery Audit Contractor Recovery Audit Contractor (RAC)(RAC)
Program Review and Update Program Review and Update
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What is the Current Status of What is the Current Status of the Permanent RAC the Permanent RAC Program? Program? The Tax Relief and Health Care Act of 2006, Section 302, required a permanent and nationwide RAC program by January 1, 2010
Provider outreach has occurred in every state All RACs have data All states are now eligible for review
FY 2009 Outreach Presentations FY 2009 Outreach Presentations
Circle = State Outreach SessionsSquare = National Presentations
Triangle = Local Presentations (Green = Regional)
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CMS RAC Review Phase-in CMS RAC Review Phase-in StrategyStrategyas of 06/24/09as of 06/24/09
Automated Review- Black & White Issues (June 2009)
DRG Validation- complex review (Aug/Sep 2009)
Complex Review for coding errors (Aug/Sep 2009)
DME Medical Necessity Reviews – complex review (Fiscal year 2010)
Medical Necessity Reviews-complex review (Calendar year 2010)
Automated Review- Black & White Issues (August 2009)
DRG Validation- complex review (Oct/Nov 2009)
Complex Review for coding errors (Oct/Nov 2009)
DME Medical Necessity Reviews – complex review (Fiscal year 2010)
Medical Necessity Reviews-complex review (Calendar year 2010)
Earliest possible dates for reviews in yellow/green states
Earliest possible dates for reviews in blue states
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Region A: Diversified Collection Services (DCS)o www.dcsrac.com (Provider Portal/Issues Under
Review) Region B: CGI Federal
o http://racb.cgi.com (Issues) Region C: Connolly Healthcare
o www.connollyhealthcare.com/RAC (Approved Issues)
Region D: HealthDataInsights (HDI)o https://racinfo.healthdatainsights.com (New
Issues)
Where are New Issues Posted?
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Pharmacy Supply and Dispensing Fees Wheelchair Bundling Urological BundlingBlood TransfusionsBronchoscopy ServicesIV-Hydration Neulasta (Pegfilgrastim)Once in a Lifetime ProceduresUntimed CodesClinical Social Worker (CSW) ServicesKnee Orthotic Bundling
Some New Issues
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Issue Name: Wheelchair Bundling Description: Bundling guidelines for wheelchair bases and
options/accessories indicate certain procedure codes are part of other procedure codes and, as a result, are not separately payable.
Provider Type Affected: DMEDate of Service: 10/01/2007 - Open States Affected: Alabama, Arkansas, Colorado, Florida,
Georgia, Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia
Additional Information: Additional information can be found in the following manuals/publications:
http://www.cms.hhs.gov/mcd/viewarticle_pdf.asp?article_id=20284&article_version=32&contractor_id=140
Example of A New Issue Posting
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What about Rebilling?What about Rebilling? Providers can re-bill for Inpatient Part B
services, also known as ancillary services, but only for the services listed in the Benefit Policy Manual. That list can be found at: http://www.cms.hhs.gov/manuals/Downloads/bp102c06.pdf
Rebilling for any service will only be allowed if all claims processing and timeliness rules are met. The normal timely filing rules can be found at: http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf
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Appeal When Necessary Appeal When Necessary The appeals process for RAC denials is the
same as the appeals process for Carrier/FI/MAC denials
Do not confuse the “RAC Discussion Period” with the appeals process
Appeals data from demonstration and going forward
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CMS Contact CMS Contact Information Information
CMS RAC Website: www.cms.hhs.gov/RAC
CMS RAC Email: [email protected]
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Questions?Questions?
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Questions: Questions:
Q. Please clarify the reason for discussion period and how the provider should include this in their process?
A. The RAC Auditors contact information will be on each demand letter and the provider would call them for discussion if there was clearly an error in the take back demand.
Q. Will interest begin at day 30 or day 41 from the date of the demand letter?
A. Interest will begin on day 30
Q. What process does the provider use to rebill Part B Ancillary services following the denial of a Part A claim.
A. See Slide 8 – Remember : Provider cannot rebill until claim adjustment is made or I/P claim is paid back.
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Questions: Questions:
Q. Does CMS anticipate starting the complex reviews earlier than January 2010?
A. No
Q. Will CAH's be reimbursed for copying cost differently than PPS hospitals?
A. Yes, CAH’s will be reimbursed on their cost report. Copy cost is an allowable Medicare cost at .12 per copy. PPS hospitals will be reimbursed monthly.
Q. Can you confirm that all deductables and copays must be returned to the patient on claims identified for takeback?
A. Yes, the beneficiary will be notified after the claim has been recouped.
