Medicare Compliance & Reimbursement

CMS using RACs to keep tabs on Medicare payments.

In the near future, physicians may notice new Medicare watchdogs on the prowl. These watchdogs, also known as recovery audit contractors, will be seeking out more information about physician claims and payments.

A demonstration in full swing in California, New York and Florida could spread nationwide, if the new RACs prove to be effective in collecting overpayments that the Medicare affiliated contractors failed to identify, the Centers for Medicare and Medicaid Services announced in an Oct. 19 Medlearn Matters article. Plan Gives RACs Freedom To Snoop Around Demo CMS' RAC initiative allows the recovery auditors to review claims to ensure proper reimbursement during the three-year demonstration, which began earlier this year.

The RACs in the selected states have a three-tiered claims review process. The first tier involves Part A diagnosis-related group reviews, which includes requests for medical records.
 
The second level involves the RAC's determination of overpayments through proprietary data mining systems, which may not include a medical record request.

Third, RACs will ask for medical records for Part B services. The three recovery companies that CMS has enlisted for this demonstration will ask providers for medical records relating to Part B services in October or November 2005, the agency says.

E-mail help: Physicians that have questions about the RAC demonstration can e-mail: cmsrecoveryauditdemo@cms.hhs.gov.

Find it online: To read the article, go to http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0565.pdf.