RACs are back

Friday, August 8, 2014

WASHINGTON – CMS announced last week that the recovery audit contractors (RACs) will restart some of their reviews, but industry stakeholders don’t expect any curveballs.

Due to delays in awarding new contracts, the agency is giving the RACs the green light to get back to work on automated reviews and, on a limited basis, complex reviews.

“It doesn’t sound like they’re authorizing new audits, just reactivating the audits that they previously allowed,” said Andrea Stark, a reimbursement consultant with MiraVista. “It’s new claims, but not new concepts.”

The RACs have been on hiatus from sending post-payment additional documentation requests (ADRs) since February, as part of CMS’s transition to new RACs.

While stakeholders agree that the bulk of the reviews affecting DME will likely be automated reviews (for example, a patient was in a skilled-nursing facility on the date of service), they’re not ruling out complex reviews.

“CMS has done so many things with the RACs to make it clear that DME is a focus, my guess is, if they’re going to pick one area to reinstate complex reviews, DME is an easy target,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group.

In the past, the RACs have performed complex reviews on respiratory assist devices (RADs) and power mobility devices (PMDs), stakeholders say.

“With so much focus on the prior approval process for PMDs, hopefully, they’ll shy away from those,” said Kim Brummett, senior director of regulatory affairs for AAHomecare.

In the wake of the news, stakeholders were keeping an eye on the RAC websites, where they’re obligated to detail their activities.

“The decision to restart the reviews isn’t illogical,” Brummett said. “The RACs aren’t making money if they’re not auditing claims.”

As always, documentation is the best defense against audits, stakeholders remind providers.

“The RACs go where the money is,” van Halem said.

CMS says it still expects to award new contracts some time this year.