A new AHIMA toolkit helps HIM professionals steer their organizations through the Recovery Audit Contractor (RAC) program.

 The “Recovery Audit Contractor (RAC) Toolkit” includes background on the program and an overview of the process, including what entities are eligible to be audited, the basis for the audits, and the type of audits. It also includes appendixes providing: (more…)

The Centers for Medicare and Medicaid Services (CMS) hopes to start Recovery Audit Contractor (RAC) automated reviews in late June and July, with more complex reviews rolling out later, according to a May 29 Health Leaders report. CMS expects to begin certain complex reviews like coding and DRG validation this fall. Medical necessity complex reviews will not begin until early 2010.

“The automated reviews are less burdensome on the provider, because there’s no request for medical records,” said Marie Casey, deputy director of the Division of Recovery Audit Operations at CMS, in the news item. “They’re also easier for the RACs to manage.”

The delay for medical necessity auditing is due to the complexity of the reviews. “We’re delaying because it’s more difficult,” Casey said. “We are really trying to ensure that when there is a difference of opinion [on the medical necessity determination of the case], the RAC clearly documents their rationale.”

The delay will also help CMS roll out an issue review team, a group comprised of members from various agency divisions that will look at policy questions, such as whether the RACs have been correct in the interpretation of coding guidelines. These teams will look comprehensively at the questions before approving new issues for RAC review, according to Kathleen Wallace, a CMS representative who spoke at a May 28 Region D RAC training session held in Helena, MT.

When record requests do come, they will start sporadically but eventually fall into a pattern, at least in Region D, said HealthDataInsights president and CEO Andrea Denko, during the Helena training session.

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that the parties involved in the protest over the award of Recovery Audit Contractor (RAC) contracts had come to a settlement. This means that the stop work order has been lifted, and CMS will continue with the implementation of the RAC program.

PRG-Shultz will serve as a subcontractor to HealthDataInsights, Diversified Collection Services, and CGI Technologies and Solutions. Viant Payment Systems will serve as a subcontractor to Connolly Consulting. According to CMS, “the four RACs will contract with subcontractors to supplement their efforts.”

The program had been suspended last November when PRG-Shulz and Viant protested the contracts that had been awarded to four others. CMS plans to have four RACs in place by 2010. Each RAC will be responsible for identifying overpayment and underpayments in approximately a quarter of the country.

The Centers for Medicare and Medicaid (CMS) has reported on the status of the recovery audit contractor (RAC) program in Medicare for fiscal year 2007. In the report, CMS highlights improvements that will be made as it implements the permanent RAC program by 2010. (more…)