CMS modifies contracts for RACs to begin reviews

The Centers for Medicare & Medicaid Services (CMS) is initiating contract modifications to current Recovery Auditor Contracts (RACs) to allow auditors to restart some reviews, due to the continued delay in awarding new RACs, CMS announced this week.

Most reviews will happen automatically, but a few will be complex reviews of topics chosen by CMS, the organization said. CMS plans to award the new round of contracts this year.

In February, CMS announced the suspension of additional documentation requests for Medicare RACs until it finished procuring RAC contracts, FierceHealthcare previously reported. The previous RAC contract ended June 1.

Earlier this year, the American Hospital Association (AHA) asked CMS to improve the RAC program by adopting reforms limiting RACs to a hard cap of additional medical records requests, Becker's Hospital Review reported. AHA also voiced concerns about the temporary suspension in administrative law judge hearings regarding RAC payment denials.  

Under the new contract agreement, RACs will conduct reviews on claims related to spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures, Becker's reported.

Also in June, CMS announced it established a provider relations coordinator to increase program transparency and help providers affected by the medical review process find resolution.

To learn more:
- here's the announcement
- read Becker's article

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