CMS Offers Anti-RAC Tool, Based on RAC Findings

Don’t the RACs work for CMS? Is it possible? Did the RACs spawn something useful?

Indeed it appears they have, if you can a) find it, b) use it wisely. The RACs have created a new CMS Learning Resource that you are probably not aware of: the Medicare Quarterly Provider Compliance Newsletter. If you go by its tagline (and you can) the newsletter’s purpose is to help you with "Guidance to Address Billing Errors". As the RAC information is beginning to rack up, CMS has found a useful way to help you use the information that they are getting back from the RACs (Recovery Audit Contractors).


You may be asking, “Penny how the heck did you find this?” And I would have to admit that I found it through a series of accidents, which culminated in a search for the source.

I came across an article called “Many RAC denials overturned on appeal” by Ron Shinkman, which was short and a bit interesting. Then I looked up his sources for the report, which included the RACTrac article with the statistics. RACTrac is interesting because it is a way for those being RAC’d to report into a pool so that statistics can be given on RAC activity, but by non-RAC sources (hospitals and such), since many don’t think the RAC is being entirely forthcoming about the information they are giving out. (You can participate in RACTrac if you would like, just go to their web site for more information.

Now, back to the facts… I read through the most recent RACTrac quarterly report and what I found interesting in their statistics was that across the country about 80% of the RAC problems weren’t from “medical necessity” issues, they were due to incorrect coding/billing issues. I also found it interesting that only 16% of the RAC denials that were available for appeal were. Currently hospitals are being hit hardest by the RACs. They have more computerized records, they are bigger fish, and the RACs get a percentage of what they find and collect. But as the hospitals get wiser and close up their billing loopholes, the RACs will be moving on to private offices (especially as more of you will be using EHRs shortly with the stimulus funding) and doing the same things.

This is where this new CMS newsletter comes in. Using information from the RACs on what coding and billing errors keep coming up, they now address these and give you the help and information in the new newsletter. All of that lost or recovered covered money, missing from your pockets. I like that the reports are showing how many of these errors are not based on Medicare fraud, just misinformation and plain old errors. All of the information in the newsletters might not apply to your private offices now, some might, but I bring it up here for you to think about and check on, because if incorrect coding and billing is the problem, then you can only imagine how these problems will be magnified in a couple of years with the ICD-10 codes. This is another wake up call for your office. Don’t just have billers in your office, invest in training trained coders. They will not only keep you out of the RACs’ clutches, and off of negative audit dockets, they will help you to find and retain more of the money you earn. Paying for it now, will continue to pay you as we all move forward into the e-healthcare future.

There are a couple of ways to find the new newsletter “Medicare Quarterly Provider Compliance Newsletter”: Google for the title and look for the PDFs (easy), or if you’re a source person like I am you will need to go to the Medicare Learning Network page at http://www.cms.gov/MLNProducts/MPUB/
You will have to click on "show only items with the following word" and put the following in the box "quarterly provider compliance". There are currently two issues available: #1 October 2010 and #2 February 2011. I was sad that the information was so hard to find on the Medicare web site, especially when I knew it existed (it felt really well buried). If you don’t know it exists, you really won’t find it. I couldn’t find anything that would let you subscribe to the newsletter right off, but you usually can subscribe to such things with CMS, so if you can, do.