Section 306 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) required CMS to complete a demonstration project to demonstrate the use of recovery audit contractors in identifying underpayments and overpayments and recouping overpayments under the Medicare program for services for which payment is made under part A or B of title XVIII of the Social Security Act. The demonstration operated from March 2005 through March 27, 2008. Section 302 of the Tax Relief and Health Care Act of 2006 (TRHCA) required the Department of Health and Human Services (DHHS) to make the RAC program permanent and nationwide by no later than January 1, 2010. CMS is planning a gradual expansion to all 50 states. The expansion schedule can be viewed at http://www.cms.hhs.gov/RAC.
What is the name and contact information for each Recovery Audit Contractor (RAC)?
Region A: Diversified Collection Services (DCS) -1-866-201-0580, www.dcsrac.com
Region B: CGI -1-877-316-7222, e-mail: racb@cgi.com, http://racb.cgi.com
Region C: Connolly Consulting, Inc. -1-866-360-2507, www.connollyhealthcare.com/RAC, RACinfo@connollyhealthcare.com
Region D: HealthDataInsights, Inc.-Part A: 866-590-5598, Part B: 866-376-2319, e-mail: racinfo@emailhdi.com
Whose claims will be reviewed under the Recovery Audit Contractors (RAC) program?
Physicians, providers, and suppliers who submit claims to Medicare.
How will the Recovery Audit Contractors (RAC) determine which claims to review?
The RACs will use their own proprietary software and systems as well as their knowledge of Medicare rules and regulations to determine what areas to review.
How long does a provider have to submit medical records when requested by a Recovery Audit Contractors (RAC)?
Providers must respond within 45 days to a RAC request for medical records. Providers may request an extension at any time prior to the 45th day by contacting the RAC.
Will the Recovery Audit Contractors (RAC)s replace all current review entities?
No. Other entities such as Medicare contractors (Carriers, Durable Medical Equipment Regional Carriers, and Fiscal Intermediaries), Program Safeguard Contractors, Office of Inspector General or Quality Improvement Organizations (QIO) could still review a provider’s claims. The RACs will not review a claim that has previously been reviewed by another entity.
How will the Recovery Audit Contractors (RAC) choose the health care entity that is to be reviewed for over-payments or underpayments? Will it be a random process?
The RACs will use their own proprietary software and systems as well as their knowledge of Medicare rules and regulations to determine what areas to review.
Who should providers contact with questions concerning Recovery Audit Contractors (RAC) communications?
Providers should first attempt to contact the Recovery Audit Contractors (RAC) through the customer service line. If that does not answer the provider’s questions and/or concerns, then the provider can contact CMS. CMS has set up a special e-mail address for the provider community to use. It is CMS RAC@cms.hhs.gov.
For the most current information: http://www.cms.hhs.gov/RAC/
For additional information, you can review the sources used for this article:
- http://www.healthcarefinancenews.com/blog/it-worth-effort-rebut-rac-findings
- http://www.bakerlaw.com/the-torture-rac-03-12-2003/
- http://www.google.com/url?sa=t&source=web&ct=res&cd=20&ved=0CCIQFjAJOAo&url=http%3A%2F%2Fwww.mcguirewoods.com%2Fnews-resources%2Fpublications%2Fhealth_care%2FRAC%2520Preparation%25207%2520Key%2520Steps%2520and%2520Best%2520Practices.pdf&ei=jM5xS8XgHoOKNOO-_PUJ&usg=AFQjCNFuk61xNPK4pD5WRc5BgP_3l5AJJQ
- http://69.63.144.78/Policy/RACprogram/rac_11_11_09.cfm
- http://health-information.advanceweb.com/editorial/content/editorial.aspx?cc=194407
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