What is the CMS Recovery Audit Project?
In 2005, the Center for Medicare and Medicaid Services (CMS) began a demonstration project in California, Florida, and New York that will use recovery audit contractors (RACs) to identify overpayments made to hospitals under program services for which payment is made under Part A or B of Title XVIII of the Social Security Act. The Medicare Modernization Act directs CMS to collect the overpayments and return them to the Medicare Trust Fund.
What is the status of the demonstration project?
The Centers for Medicare & Medicaid Services in the next few weeks will release a final report on the overall outcome of the Medicare recovery audit contractor demonstration, CMS officials told the AHA recently. Following the report, the agency plans to announce the permanent RACs for the nationwide rollout. Congress in 2006 made the program permanent and required CMS to operate RACs in all 50 states by 2010.
How will CMS pay the private recovery audit contractor firms?
CMS will pay the RACs on a CONTINGENCY basis only. CMS will issue the payments as soon as the recovery audit contractors have collected the Medicare overpayments from the hospitals. On the underpayment side, RACs receive a contingency fee only for flagging a partial underpayment (e.g., a missed complication/ comorbidity or major CC).
How will the RACs conduct the audits?
The RACs will conduct initial electronic screenings using proprietary software, experiences, and resources to identify overpayments, as well as the CMS complex medical record review process which includes reviewing medical records. As soon as they identify overpayments, the RAC will send a spreadsheet to each hospital which lists all claims containing overpayment determinations. The report will include a specific CMS regulation citing why the claim was determined to have been overpaid. The hospital can then accept the RAC decision and remit the overpayment or appeal the determination. Hospitals must file appeals within 15 days of the receipt of the determination.
What can I do to protect my hospital during a Recovery Audit Project?
Coding experts say doctors and hospitals that don't prepare now for the upcoming federal crackdown on Medicare billing could face six-figure bills, referrals to fraud enforcers, and possible jail time. If you prepare early on, you send a message to the RAC that your hospital is compliant. Contact LMS for information on our Recovery and Defense Audit Program – AccuRAP. We can assist you in recovering Medicare underpayments and process your RAC appeals.
What can I do to protect my hospital during a Recovery Audit Project?
Contact LMS for information on our Recovery and Defense Audit Program – AccuRAP. We can assist you in recovering Medicare underpayments and process your RAC appeals.
ARE YOU READY FOR THE CMS AUDIT RECOVERY PROJECT?
Please email LMS today to discuss how we can prepare you for the CMS Recovery Audit Project.
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