Tag: RACs

WASHINGTON - CMS has tapped Performant Recovery to perform post-payment reviews of Medicare claims for DMEPOS and home health/hospice nationwide.The other RACs awarded contracts will perform post-payment reviews to identify and correct Medicare claims that contain improper payments that were made under Part A and Part B for all provider types other than DMEPOS. Performant Recovery also won that contract for Region 1. Cotiviti won contracts for Region 2 and 3, and HMS Federal Solutions won a contract...

BALTIMORE - CMS has released requests for proposals for the next round of the recovery auditor contracts.Until new contracts are awarded, CMS has indicated that the RACs may resume auditing activities, including sending additional documentation requests or ADRs, upon signing a contract modification. The modification allows the RACs to conduct these activities through July 31, 2016.If a RAC chooses not to sign the modification, providers should note that Oct. 16, 2015, was the last day the RAC could...

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...

ORLANDO, Fla. - The Medical Equipment Suppliers Association (MESA) has heard back from CMS about why DME providers, unlike hospitals, aren't reimbursed for the costs of providing copies of records to respond to audits. Following a Senate roundtable on audits in July, where it was revealed that the RACs pay hospitals up to $25 per audit, the association recommended the agency change the policy. Acting Director of the Provider Compliance Group Melanie Combs-Dyer told Executive Director Liz Moran in...

WASHINGTON - CMS has announced that the current recovery audit contractors (RACs) will restart some of their reviews.The RACs have been on hiatus from sending post-payment additional documentation requests (ADRs) since February, as part of the agency's transition to new RACs.But, apparently, that transition is taking longer than CMS anticipated.“Due to the continued delay in awarding new recovery auditor contracts, CMS is initiating contract modifications to the current recovery auditor contracts...

WASHINGTON - The Government Accountability Office (GAO) this week signed off on Medicare's plan to pay RACs for audits of hospitals only if a second-level appeals judge upholds their findings, according to news reports. The change is one of several that CMS plans to put in place as part of signing on a new group of RACs in 2014. “At this point, I do not think that the change will impact how much the RACs get paid, since appeals to the first and second levels are almost always decided in...

As Elmer Fudd would say “Be vewwy, vewwy quiet...I'm hunting wabbits!” The Centers for Medicare and Medicaid Services (CMS) may not be hunting rabbits, but they're hunting the very elusive greenbacks. On September 1, 2012, CMS implemented the prior authorization (PA) for power mobility devices (PMDs) demonstration in seven states: Cal., Fla., Ill., Mich., N.C., N.Y. and Texas. CMS claims that spending per month on power mobility devices in the seven demo states has decreased since September...

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...

WASHINGTON - A bill that would require Medicare to pay only licensed providers for orthotics and prosthetics (O&P) is a proverbial hat trick, say stakeholders.“It would save money for the government, it would cut back on fraud, and it would aid patients by assuring that a higher quality of care is available to them,” said Tom Fise, executive director of the American Orthotics and Prosthetics Association (AOPA).The Medicare Orthotics & Prosthetics Improvement Act of 2013, H.R. 3112, was...

WASHINGTON - A new report from the Office of Inspector General (OIG) says that while CMS took corrective actions to address the majority of the vulnerabilities it identified, the agency did not evaluate the effectiveness of these actions.“As a result, high amounts of improper payments may continue,” the report states.The OIG found that, of 2.6 million claims reviewed in 2010 and 2011, the RACs identified 1.3 million as having improper payments—at a cost of $1.3 billion.During those...