Overview

CMS Update - June 26, 2009: CMS is often asked about the phase-in strategy for RAC reviews. CMS has implemented a phase in strategy by review type. CMS' phase in strategy can be found in the downloads section on the recent updates page. CMS has not put a phase in strategy in place by provider type. All provider types are available for RAC review once provider outreach has occurred in the state. Any reviews completed by the RAC must have been first approved by CMS and posted to the RAC websites. The RAC websites can be found in the RAC contact information document in the downloads section below. CMS expects the first approved new issues to be posted in July 2009.

CMS is often asked about other claim types that may be affected by a full inpatient denial and if the RACs will deny other claim types associated with the inpatient stay, such as physician evaluation and management services. At this time the RAC will not automatically deny claims that are associated with a full inpatient denial. However, these claims may be reviewed individually and there may be a need to fully/partially adjust the claim based on the documentation submitted. 

 Protest Resolved: On February 4, 2009 the parties involved in the protest of the award of the Recovery Audit Contractor (RAC) contracts settled the protests.  The settlement means that the stop work order has been lifted and CMS will now continue with the implementation of the RAC program. 

Under the program, the four RACs will contract with subcontractors to supplement their efforts.  PRG-Schultz, Inc. will serve as a subcontractor to HDI, DCS and CGI in regions A, B and D.  Viant Payment Systems, Inc. will serve as a subcontractor to Connolly Consulting in region C.  Each subcontractor has negotiated different responsibilities in each region, including some claim review.   

The RAC in each jurisdiction is as follows:

Region A:  Diversified Collection Services (DCS) 

Region B:  CGI 

Region C:  Connolly, Inc. 

Region D:  HealthDataInsights, Inc.

All correspondence, websites and call centers will be in the name of the RACs above. Click the link below to obtain contact information for each RAC.

RAC Permanent Program:  Section 302 of the Tax Relief and Health Care Act of 2006 made the RAC Program permanent and required the Secretary to expand the program to all 50 states by no later than 2010.  See below for a link to the text of this legislation.  

Each RAC is responsible for identifying overpayment and underpayments in approximately ¼ of the country. The RAC jurisdictions match the DME MAC jurisdictions.  See below for a link to the RAC Jurisdiction Map.

Downloads
Additional Links for Providers [pdf, 11.48kb] CA Outreach Presentation [pdf, 37.77kb] RAC Contact Information [pdf, 58.23kb] Tax Relief and Health Care Act of 2006, Section 302 [pdf, 29kb] Map of Future RAC Jurisdictions [pdf, 154kb] Recovery Audit Contractor (RAC) Program Slide Presentation [pdf, 56.95kb] Final RAC Statement of Work [pdf, 252.14kb] RAC Subcontractor Information [pdf, 8.51kb]
Related Links Inside CMS
2008 Press Release Announcing New National RACs 2008 RAC Fact Sheet Frequently Asked Questions Get Recovery Audit Contractor (RAC) e-mail updates MM 6183 Limitation on Recoupment (935) [pdf, 420kb] MLN The Medicare Appeals Process Brochure [pdf, 1.23mb]
Related Links Outside CMS
CR 6183 Limatation on Recoupment (935) [pdf, 420kb]

Page Last Modified: 02/23/2010 7:56:43 AM
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