AANEM News Express

AANEM News Express

CMS Suspends RAC Audits

3/26/2014
 
The Centers for Medicare & Medicaid Services (CMS) recently announced a temporary suspension of its new recovery audit contractor (RAC) audits until sometime this fall. The agency will re-evaluate its contracts and makes changes to its RAC contract guidelines in an effort to reduce the burden on physicians and protect against erroneous determinations. This re-evaluation was made possible largely by the lobbying efforts of the American Medical Association (AMA).
 
CMS announced the following changes to the RAC audit program:
  • RACs must wait 30 days after making a claims determination before sending the claim to the Medicare administrative contractor (MAC).
  • RACs are now required to confirm within three days that they have received a request and notify the physician.
  • Instead of RACs receiving their contingency fee directly from the recoupment of payments they deemed “improper,” they must wait until the physician has exhausted the second level of appeal if the physician chooses to appeal.
  • The creation of separate additional document requests (ADRs) limits for different claims types.
  • A requirement for RACs to adjust the amount of ADRs a provider can receive based on their denial rate (i.e., if a provider has a low denial rate, then it will receive fewer ADRs, and vice-versa.)
 
Efforts by the AMA, with the support of AANEM, will continue to press CMS to eliminate the burden placed on physicians under the RAC program.


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