Oct

16

CHANGES COMING: Key differences in nationwide rollout

By The RAC Report

Now that you know which RAC will come to your facility, it’s time to prepare for some changes. CMS revamped the program after the three-year demonstration project, and providers can expect to see the changes reflected in the nationwide permanent program.

Chief among them are:

RAC medical director.
Demonstration RACs: Not required
Permanent RACs: Mandatory

Coding experts.
Demonstration RACs: Optional
Permanent RACs: Mandatory

Credentials of reviewers provided upon request.
Demonstration RACs: Not required
Permanent RACs: Mandatory

Discussion with CMD regarding claim denials if requested.
Demonstration RACs: Not required
Permanent RACs: Mandatory

AC validation process.
Demonstration RACs: Optional
Permanent RACs: Limited

External validation process.
Demonstration RACs: Not required
Permanent RACs: Mandatory

RAC must pay back the contingency fee if the claim is overturned on appeal.
Demonstration RACs: Only required if claim is overturned on the first level of appeals
Permanent RACs: Required if claim is overturned at all levels of appeals

Maximum look back date.
Demonstration RACs: None
Permanent RACs: October 1, 2007

RACs allowed to review claims in current fiscal year.
Demonstration RACs: No
Permanent RACs: Yes

RACs solely for MSP.
Demonstration RACs: Yes
Permanent RACs: No

RAC claim status Web page.
Demonstration RACs: Not required
Permanent RACs: By January 2010

Limits on number of medical records requested.
Demonstration RACs: Optional. Each RACs set own limit
Permanent RACs: Mandatory. CMS will establish uniform limits.

Editor’s note: For more differences in the permanent program, see the next edition of The RAC Report October 30, 2008.