RAC Audits Put on Hold Temporarily

by | Published on Apr 30, 2014 | Healthcare News

RCA Audits
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With a view to allow existing contracts with audit contractors to expire, the CMS has temporarily halted new RAC audit requests effective February 21st. The Recovery Audit Contractors (RACs) currently under contract to CMS were directed to stop sending post-payment ADRs (Additional Documentation Requests) to providers until further notice. CMS’ RAC “over aggressive” audit program had come under considerable pressure from more than 111 individual members of congress.

CMS hopes to clear any backlog that exists before beginning its new contract review cycle. It wants to minimize any carryover in case new contractors are selected. In tandem with its suspension of new audits, CMS also announced changes to the Recovery Audit Program that may be incorporated into the new RAC contracts. These new changes are expected to make the program more effective and efficient, improving accuracy, reducing provider burden and ensuring more program transparency. The changes include:

  • RACs will have to wait 30 days before asking a Medicare Administrative Contractor (MAC) to adjust a claim payment. This will allow the physicians to discuss the audit with the RAC. (earlier, physicians had to choose between starting a discussion and filing an appeal)
  • RACs will have to let physicians know that they have received the requests for discussion within 3 days. (earlier auditors did not have to confirm that they had received such requests)
  • RACs will not any more receive their contingency fee immediately after recovery of payments they judged “improper”. In case a physician chooses to appeal an audit, the RAC will have to wait until the physician has completed the 2nd level of appeal.

Physicians should bear in mind that though the RAC audits have been temporarily suspended, automated reviews that don’t require medical record documentation will continue through June 1. Moreover, RACs will be completing audit requests sent through February 28 that required further documentation.

Currently, physicians have 45 days to respond to RAC documentation requests and RACs have 60 days to pronounce a verdict on the claim.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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