New national RAC for HME?

Friday, August 28, 2015

YARMOUTH, Maine – A tug of war between CMS and the RACs over planned changes to contingency fees could lead to a new national RAC for HME, says Andrea Stark.

As part of its latest requests for proposals, CMS announced plans to implement a number of changes to its RAC program and one, in particular, has driven two contractors to file protests: The agency wants to prevent the RACs from collecting contingency fees until the second level of appeals is exhausted.

“CMS has paid out beaucoup dollars,” said Stark, a reimbursement consultant with MiraVista, during a webcast last week.

In the wake of the controversy, CMS announced this summer that it will update its statement of work for the contracts and release new RFPs “shortly.”

Stark believes that CMS will also rescind the contract for Connolly, which was named as the national RAC for HME, home health and hospice late last year. 

“If you redo one, you should redo them all,” she said.

Until CMS releases additional guidance, the agency has instructed the current RACs—Performant Recovery, CGI Federal, Connolly and Health Data Insight—to keep doing what they’re doing.

“They’re sitting back and riding the tide,” Stark said.

As to what the new statement of work will look like: Stark says she doesn’t know whether or not the changes to contingency fees will survive.

“There has to be a balance between protecting providers and allowing the RACs to do their jobs,” she said. “That’s the balance CMS is trying to figure out.”