What is the CMS Recovery Audit Project?
Section 302 of the Tax Relief and Health Care Act of 2006 requires the Secretary of the Department of Health and Human Services (the Secretary) to utilize RACs (Recovery Audit Contractors) under the Medicare Integrity Program to identify underpayments and overpayments and recoup overpayments under the Medicare program associated with services for which payment is made under Part A or B of title XVIII the Social Security Act.
What is the status of the demonstration project?
On February 4, 2009 the parties involved in the protest of the award of the Recovery Audit Contractor (RAC) contracts settled the protests. The settlement means that the stop work order has been lifted and CMS will now continue with the implementation of the RAC program. By 2010, CMS plans to have 4 RACs in place. Each RAC will be responsible for identifying overpayment and underpayments in approximately ¼ of the country. The new RAC jurisdictions match the DME MAC jurisdictions.
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 – AccuRAC. 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 – AccuRAC. 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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