CMS to suspend RAC requests

The Centers for Medicare & Medicaid Services announced it will suspend additional documentation requests (ADRs) for Medicare recovery audit contractors until it finishes procuring new RAC contracts.

The ADR pause begins at the end of business today. Feb. 28, is the last day CMS will accept ADRs made by Medicare Administrative Contractors participating in the RAC prepayment review demonstration pilot.

"It is important that CMS transition down the current contracts so that the Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts," the announcement states. "In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program."

CMS will also require RACs to base the amount of ADRs providers can review on the provider's claim denial rate, according to Bloomberg BNA. For example, a low-denial provider will have a lower ADR amount.

CMS estimates new RACs contracts will last through 2018. Furthermore, the agency will assess the existing review and communication timeframes for ADRs between RACs and providers, according to the CMS announcement.

Earlier this month, 111 bipartisan House of Represetatives members signed a letter to Health and Human Services Secretary Kathleen Sebelius calling for RAC reform, FierceHealthFinance previously reported.

The letter noted that RACs receive a commission that essentially incentivizes claims denial, and urged Sebelius and CMS to consider an alternative payment model. "Medicare beneficiaries and those who provide them with care have an important stake in ensuring the RAC auditing process is fair and effective," the letter stated. "We urge you to take immediate action before we see further problems with the RAC auditing program."

To learn more:
- here's the CMS announcement
- here's the Bloomberg BNA article