RAC Contracts

Recovery Auditor activity has been quiet of late.  CMS’ Contracts with the vendors were extended on a few occasions to cope with technical issues.  The contracts originally had an expiration date of February, 2014. 

On October 31, 2016, CMS announced that they awarded the next round of Medicare Fee for Service Recovery Audit Contractor contracts to three companies to cover five regions.  The breakdown is as follows:

Region 1 – Performant Recovery, Inc.
Region 2 – Cotiviti, LLC
Region 3 – Cotiviti, LLC
Region 4 – HMS Federal Solutions
Region 5 – Performant Recovery, Inc.

The RACs listed for Regions 1-4 perform postpayment reviews for Medicare Part A and B for all provider types except Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice.  Region 5 will handle DMEPOS and Home Health/Hospice. 

The new contracts stipulate new audit timelines, reducing the look-back period on claims.  In addition, RACs now receive payments only after a provider has exhausted two levels of appeal. 

CMS plans to publish more information on the implementation of the new RACs on their website at:  https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/recovery-audit-program/recent_updates.html

As always, if you need assistance, Corcoran Consulting Group can help with coding, documentation, and reimbursement questions or to provide training or chart review and compliance questions.  Visit our website or call us to learn more.  You can link to our new App, Corcoran 24/7 via one of the links below.

www.corcoranccg.com   (800) 399-6565