CMS Special Open Door Forum: Medicare Fee-For-Service Recovery Auditor Prepayment Review Demonstration
We recorded the second CMS Special Open Door Forum for the Recovery Audit Prepayment Review Demonstration, conducted by CMS on December 21, 2011. The project will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional “pay and chase” methods of looking for improper payments after they occur. Contact: RAC@cms.hhs.gov
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ADR Limits for CMS RACs Increase For Smaller Providers
CMS posted “Additional Documenation Limit Update for Providers” today, a document dated August 15, 2011, outlining changes for the number of Additional Documentation Requests (ADR) that a Recovery Audit Contractor can request from providers, excluding suppliers and physicians. The change takes effect today, August 22, 2011.
CMS Provider Compliance Group To Address OIG and RAC Issues: August 23-25,2011
CMS announced a series of calls on specific Medicare program vulnerabilities identified in HHS Office of Inspector General (OIG) reports. Some of the issues being addressed on the calls correspond to some recently posted RAC Approved Issues. Since CMS has included specific emails for sending in questions before the sessions, provider may wish to compose and send off questions about these issues. The issues listed by CMS are vague enough as to allow for quite a broad range of questions, particularly for the Day Two topics. Find a complete PDF of topics, dates and times below. Continue reading
CMS Medicare Recovery Auditors Paid 50% More for Inpatient vs. Outpatient Overpayments
[This report is the second of a two-part article on this subject.]
RACs Incentivized More for Part A Claims than for Part B Claims
CMS incentivizes the Medicare Recovery Audit Contractors (RACs) by weighting their contingency fees based upon the type of improper payments found by RAC auditors. We previously reported that RACs do not often get their full contingency fee, ranging from 9% to 12.5%, when they correctly identify an overpayment made to a provider. 
Instead, although they receive their full contingency fee for finding any underpayments, they only receive 75% of their fee for Inpatient claims (from hospitals and other healthcare facilities), and only 50% for Outpatient claims (from physicians and other healthcare providers). Continue reading
Medicare Underpayments Pay The Best for CMS Recovery Auditors
[This report is the first of a two-part article on this subject.]
RACs Incentivized via Payment Table in Statement of Work
CMS incentivizes the Medicare Recovery Audit Contractors (RACs) by weighting their contingency fees based upon the type of improper payments found by RAC auditors. It is a little known fact that RACs do not often get their full contingency fee, ranging from 9% to 12.5%, when they correctly identify an improper payment made to a provider. Continue reading
CMS: RACs To No Longer Send Out Demand Letters
Claims Contractors Will Issue Demand Letters
CMS Medicare Administrative Contractors (MACs) will issue all demand letters for Recovery Audit Contractor (RAC) identified overpayments, beginning January 3, 2012, according to MLN Matters® article issued July 29, 2011. The change “reflects the program’s desire to increase consistency and efficiency through automation,” according to the Change Request (CR) Transmittal associated with the article. Continue reading