|
RAC Questions and Answers
During our RAC webinars, participants were allowed
an opportunity to ask questions. Here are a few of
those questions and the answers as follow-up to the
webinar.
- If a provider has performed a self-audit prior to
RAC review and want to extrapolate these findings,
will all these claims included in a self-audit be
excluded from RAC review?
Answer:
Yes; If a provider self-discloses a payment error and
the Claims Processing Contractor confirms that a
payment error exists and the sampling / extrapolation
methodology used was correct, then these claims will
not be reviewed by the RAC. The claims processing
contractor will exclude the self-disclosed claims in the
RAC data warehouse.
- Will the RACs receive a full contingency fee for
claims in which they utilize the extrapolation procedure
outlined in the SOW?
Answer:
Yes, RACs will receive their full contingency fee for
extrapolated claims.
Find out more Q & A's....
|
|
| |
Greetings!
If you have been attending our RAC webinars, you will
find this newsletter issue an important addendum to
the information that you have already received from us
regarding CMS RAC AUDIT process.
August 1st is fast approaching for those states that
will be phasing in. Time is short to get your pre-audit
process in place if you have not already done so.
Within this newsletter you will find a few of the latest
questions we have encountered during our ongoing
webinars as well as their answers.
If you have not yet registered for one of our webinars, I
encourage you to check us out and register today.
This will be the perfect opportunity to ask questions of
our RAC consultant that you may not be able to get
answered easily from other sources.
|
| |
| |
| |
| Automated RAC AUDIT dates are announced |
| |
Marie Casey, Deputy Director of the Division of
Recovery Audit Operations at CMS has
announced "automated audits will begin in late June
and July," admitting there will still be leeway here.
She further indicated complex audits won't begin until
later and will actually start with things such as coding
and DRG validation. Medical necessity complex
reviews most likely will not begin until early 2010.
EARLIEST POSSIBLE REVIEW DATES FOR BLUE
STATES IN AUGUST 1 PHASING-IN
- Automated Review-Black & White Issues (August
2009)
- DRG Validation-complex review (Oct/Nov 2009)
- Complex Review for coding errors (Oct/Nov 2009)
- DME Medical Necessity Reviews-complex review
(Fiscal year 2010)
- Medical Necessity Reviews-complex review
(calendar year 2010)
|
| |
|
| |
| August 1st Phasing In of New States |
| |
These are the states (blue on map) that CMS has
targeted for August
1, 2009 phasing in...
- Alaska
- Washington
- Oregon
- Idaho
- Nebrask
- Kansas
- Iowa
- Missouri
- Arkansas
- Louisiana
- Wisconsin
- Michigan
- Alabama
- Mississippi
- Georgia
- Tennessee
- Virginia
- West Virginia
- North Carolina
- Kentucky
- Ohio
- Pennsylvania
- Maryland
- Delaware
- New Jersey
- Connecticut
|
| |
To see map, click here... |
| |
| CMS Demand Letter |
| |
Many have asked what can they expect in the way of
communication from CMS regarding recovery
demands. By clicking on the link shown below, you will
see a copy of a "demand letter".
|
| |
Click for Demand Letter.... |
| |
|
