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  • Protest Dismissed, CMS Will Move Ahead With RAC Contracts

    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protests were launched against the CMS effort to award new contracts, with all but the CGI protest being dismissed or withdrawn.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.


    • APTA has been working with the wrong people, it seems. Since this current Administration and Congress have allowed the transfer of health care dollars from the Medicare system to support the funding of the ACA, there have been an increase in the regulations, and CMS has more power to regulate the Medicare benefits that I and millions of other hard working retirees have earned through taxation of our earnings through the years. I am hopeful that all of us 50-,60- and 70-somethings, the Baby Boomers, stop being such nice people and start to stand up for our true entitlements, in addition to the entitlements of those 70-,80- and 90- something people that we are treating and serving. We have watched the erosion of reimbursement from CMS lead us into an era of "insurance centered health care." Where are you people? Am I the only one who sees this? Why aren't we protesting the decrease in reimbursement, artificial cap, stress and forced "game playing" that we have to do to keep afloat? I know that Florence Kendall would be rolling over in her grave if she knew what the world of PT has come to in this age of EMR, PQRS,G-codes- what happened to helping patients regain their lives after injury, helping them to cope and recover from the after effects of surgery and illness, and teaching people how to live healthier and safer lives? Why can't we pursue these goals effectively in any setting now unless it is pro-bono or within a student clinical setting? The past 44 years of my career(Happy anniversary to fellow U of MD graduates, class of 1970!)have seen so many changes in our profession, but even with the DPT degree, we still are not seen as professionals, but more on the lines of paraprofessionals who happen to have some medical knowledge. We as an Association do not really represent all the PT's in the country well to Congress, the CMA or the Administration,as they and/or the corporations who "own us" are now dictating what we say in our documentation because of reimbursement, and they seem not to care about what is actually happening with our patients! As I said to the former Rehab Director of the facility where I am working PRN through a traveling company, this is not what I signed up for! Artificial productivity standards are stressful and I believe counter-productive, because the focus is no longer patient centered care but reimbursement and profit. Since my very first job in rehab, the focus of PT has shifted - yes, we have the Practice Guidelines, and that we Standards of Practice and Ethical Guidelines- but "successful" practices are now those that are profit driven, not patient centered. I just want to treat patients again, using my knowledge, evidence and experienced based, excellent standards of practice, bring back the "art" of physical therapy, and even pass on the love of being a physical therapist to the new and future grads! But in the meantime, I have to listen to the "if you had treated this patient for 3 more minutes, we would have 'captured' $25.13 more." Happily, I don't have to listen to that again, I have the option, which I exercised, to tell my company,"I'm out of here!" But so many new grads are running into this from large to small company owners,in acute,subacute and rehab settings, in outpatient clinics, and in long term care- and the paperwork in the school systems and home health settings in this country are beyond belief! Even the government at VA hospitals and military treatment facilities track your productivity! I have felt that we have been reduced in many cases to the level of widget makers, because patient progress is no longer our "most important product," but the pursuit of the almighty dollar is paramount, and regulations are dictating how many minutes we do anything! Life was better in the good old days, without the time clocks and emphasis on "good time management." It is unethical and Medicare fraud to bill for the documentation we are now forced to do to justify medical necessity- when the doctors have already agreed it is necessary(each month, or less), and the Administrative Law Judges' only care if the patient got better and made progress! (yes, in my career I have been down that route also!) Acronyms and the computer age has changed who we are, also-I do appreciate the ability to find out information on the Web, but who has time on the job to look up very many things? Meeting with your team members concerning patient care is important- but who can afford to pay people to have meetings anymore? It's "non-productive" time according to the clock! Well, it's Saturday morning and I choose not to work - so thank you for reading to the end of my rant! I am looking for solutions, but right now think I will just wait for any of you to comment.

      Posted by Laurie Coykendall on 8/30/2014 11:11 AM

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