CMS announces changes for RAC program

AHA News Now

The Centers for Medicare & Medicaid Services last week announced changes to its Recovery Audit Contractor Program that the agency believes will reduce provider burden, enhance CMS’s oversight and increase transparency in the program. Among other changes, some of which were originally unveiled by the agency last February, CMS will limit the RAC look-back period for patient status reviews to six months after the date of service if the hospital has submitted its claim within three months of the date of service. CMS believes this addresses concerns regarding its policy that limits hospitals’ ability to rebill certain denied Medicare Part A claims under Part B to one year after the date of service. CMS says the changes will be effective with each new RAC contract, beginning with the contract for RAC Region 5 that the agency awarded Dec. 30 to Connolly LLC to identify nationwide improper Medicare payments made to suppliers of durable medical equipment, prosthetics, orthotics and supplies and to home health and hospice agencies. In addition, CMS says the new RAC contracts for Regions 1, 2 and 4 remain under “a pre-award protest,” which is expected to continue into the summer, and it hopes to finalize soon the RAC contract for Region 3.

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