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 Consulting, 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 makes the RAC Program permanent and requires 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.  This web page describes CMS' strategy for expanding from a 3-state demonstration RAC Program to a 50-state permanent RAC Program.

Implementation Strategy:  By 2010, CMS plans to have 4 RACs in place.  Each RAC will be responsible for identifying overpayment and underpayments in approximately ¼ of the country. The new RAC jurisdictions match the DME MAC jurisdictions.  See below for a link to the RAC Jurisdiction Map.

The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers. It has provided CMS with a new mechanism for detecting improper payments made in the past, and has also given CMS a valuable new tool for preventing future payments. 

• Step 1 - Expand the Current RACs:  In the Spring of 2007, CMS added one state to each of the current 3 RAC jurisdictions.   
• Step 2 - Full and Open Competition for 4 RAC Jurisdictions: In the Spring of 2007, CMS began the process to procure 4 RAC contractors through a full and open competition.  On March 16, 2007 CMS released a Request for Information (RFI) which contained a draft statement of work. On August 16, 2007 CMS released a pre-solicitation notice which contained a statement of work. On October 19, 2007, CMS released a Request for Proposal (RFP) which opened a Question and Answer period. On November 7, 2007, CMS posted a revised Statement of Work. Answers to the questions were posted on November 19, 2007. See below for link.

On October 6, 2008, CMS announced the names of the new national RACs. The new RACs are:

• Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont,  Massachusetts, Rhode Island and New York. 
• CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.
• Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
• HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each RAC region in 2009.

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] RAC Expansion Schedule [pdf, 61.0kb] 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: 10/08/2009 2:00:13 PM
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