FWA Briefs

Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

RAC Ramp Up for 2017

  • by Margaret Klasa DC, APN BC
  • Feb 27, 2017, 13:01 PM

The five regional Recovery Audit Contractors (RACs) are ramping up their automated and complex reviews starting this month.  The Centers for Medicare & Medicaid (CMS) Medicare Fee for Service (FFS) audit program awarded contracts in October 31, 2016 to the following contractors:

Region 1 – Performant Recovery, Inc.

Region 2 – Cotiviti, LLC

Region 3 – Cotiviti, LLC

Region 4 – HMS Federal Solutions

Region 5 – Performant Recovery, Inc.

Post-payment reviews will identify the Part A and Part B improper payments for all providers in Region 1-4.

Region 5 RAC contractor Performant Recovery is unique in that it is nationally dedicated to perform post-payment reviews of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) and Home Health and Hospice.

During these RAC calls it is important to note that  CMS Program Integrity drives these audits through combined sources such as Local Coverage Decisions (LCDs), National Coverage Decisions (NCDs), Program Integrity Manuals, as well as coding guidelines.

We at Context 4 Healthcare can provide you and your organization with a real-time web based Program Integrity Platform that will reduce audits, errors, and reduce cost. By utilizing our expertise in Program Integrity we can assure you that your claim submissions and in-house audit programs remain RAC compliant.

Let us assist you with your Program Integrity by contacting sales to see how Context 4 Healthcare’s Program Integrity Platform can help you.

Proudly Affiliated with:

Proud_Members_Logo_250X100   National Association of Dental Plans Member   FedRAMP  Amazon Web Services