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RAC Procurement Updates - New Contracts Under Pre-Award Protest

  • by Margaret Klasa DC, APN BC
  • Dec 8, 2014, 10:03 AM

RAC Contacts Under Pre-Award ProtestIt is almost the end of the year and no new Recovery Audit Contractors (RAC) contracts have been awarded. The Centers for Medicare & Medicaid Services (CMS) has recently posted a RAC procurement update stating that as of November 4, 2014, the new contracts for Recovery Auditor Regions 1, 2, and 4 remain under a pre-award protest, which is expected to continue into late summer of 2015. The procurement process continues for Region 3 (Part A / Part B claim reviews), which includes Florida, Tennessee, Alabama, Georgia, West Virginia, Virginia, North Carolina and South Carolina. Also, Region 5, which will be the national contract for DMEPOS and Home Health & Hospice claim reviews procurement process continues. The CMS remains hopeful that these two new contracts will be awarded before the end of this year. http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html

According to the CMS, “the Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.” http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/

Context 4 Healthcare can help providers address coding and compliance challenges with our clinical editing solution. ClaimsEditor® plays an instrumental role by utilizing advanced clinical editing technology to ensure that both institutional and professional claims are properly coded and compliant with applicable payer requirements. ClaimsEditor® examines the whole claim and identifies procedure-to-diagnosis mismatches, unbundling occurrences, use of nonspecific diagnosis codes, global service violations, potential unbilled revenue, and many other problem areas that can adversely affect not just claims processing, but a provider’s overall practice. Claims editor is deployed using cloud or client server based technologies.

Read other RAC updates from the Compliance Edge blog: RAC Audit Identifies Overpayments for Billing Incorrect DME Codes; CERT Program Monitors CMS FFS Improper Payments - $36 Billion in 2013

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