The Centers for Medicare and Medicaid Services (CMS) will move ahead with awarding new contracts to Recovery Audit Contractors (RACs) now that the US Court of Federal Claims has ruled against the last standing protest opposing the new arrangements. The protest, leveled by CGI Federal, Inc, led CMS to suspend RAC reviews while the case was being decided.
The new RAC contracts are expected to contain changes to the audit process announced in February. According to CMS, the changes are designed to "result in a more effective and efficient program, including improved accuracy, less provider burden, and more program transparency." Planned changes include a mandatory 30-day wait for discussion before a claim is sent to Medicare Administrative Contractors (MACs) for collection, a requirement that RAC contingency fees will only be awarded after the second level of appeal has been exhausted, and a rule that additional documentation request (ADR) limits be adjusted based on the provider's compliance rate.
According to a recent article in Inside Health Policy, several protests were launched against the CMS effort to award new contracts, with all but the CGI protest being dismissed or withdrawn. Initially, CMS moved to wind down activities of the current RACs, but as the CGI protest lingered, the agency announced that it would restart the program under the current auditors. The Inside Health Policy article reports that those restarted program contracts had not yet been signed when the court ruled in favor of CMS, allowing CMS to refocus on awarding new contracts.
APTA is working with CMS officials to produce more effective review systems that would reduce administrative burden, improve communication among their contractors, focus investigation and review efforts on the highest risk cases, and minimize disruption to providers. APTA expects to receive more information from CMS in the coming weeks on how and when RAC reviews will resume, including specific information on therapy cap manual medical review.
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