Confusion permeates RAC transition

Friday, March 21, 2014

YARMOUTH, Maine – The first few weeks of CMS’s wind-down of audits by the current group of recovery audit contractors (RACs) have brought confusion to some providers.

Provider Ron Evans says, although the volume has declined in March, he’s still receiving additional documentation requests (ADRs).

“We’ve gotten about 20 pre-pay reviews for oxygen and complex medical reviews for CPAP,” said Ron Evans, owner of Valley Respiratory Services in Phoenix, Ariz. “They are dated between March 4 and March 12.”

Feb. 21 was supposed to be the last day the RACs could send a post-payment additional documentation request (ADR) and Feb. 28 was supposed to be the last day a MAC could send pre-payment ADRs for RACs to review. June 1 is supposed to be the last day RACs can send improper payment files to the MACs for adjustment.

One thing for providers to be aware of, stakeholders say: Other audits, besides RAC audits, are still a go.

“Providers are still getting requests for documentation from other sources and have them confused with RACs,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “The Medicare administrative contractors (MACs) still have the authority to review claims for reasonableness and medical necessity at any time. It is very confusing.”

Industry consultant Andrea Stark says she hasn’t heard of any new requests from the RACs.

“Based on mailing protocols, there may have been some delays in the mail getting to the supplier, but those letters should not be dated after Feb. 28,” said Stark, a reimbursement consultant with MiraVista.

Another possible reason for the confusion: Maybe not all contractors have gotten the word, stakeholders say.

“Sometimes the RACs or MACs don’t always get the clear message,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “I would call them up.”

That’s just what Huntington Beach, Calif.-based Diversified Medical Equipment and Supplies did after receiving new ADRs in March.

“They said, ‘We know there’s a transition but nobody’s told us to stop,’” said Adrian Ioja, general manager, who heard the same from another local provider. “We have no choice but to continue to respond to the requests.”