CMS announced several changes to the Recovery Audit Contractor (RAC) program as it begins the procurement process for the next round of program contracts.
According to a release from the National Association for the Advancement of Orthotics & Prosthetics (NAAOP), CMS has paused RAC audits until new RAC contracts are issued. Although it is not clear when the new RAC contracts will go into effect, NAAOP believes it should be at least several months.
CMS also announced that Feb. 21 is the last day a recovery auditor may send postpayment additional documentation requests (ADRs) and Feb. 28 is the last day a Medicare Administrative Contractor (MAC) may send prepayment ADRs for the recovery auditor prepayment review demonstration. Finally, the last day a recovery auditor may send improper payment files to the MACs for adjustment is June 1.
Additional changes include a 30-day wait requirement for recovery auditors to allow for a discussion before sending the claim to the MAC for adjustment, so providers will not have to choose between initiating a discussion and an appeal; a requirement for recovery auditors to confirm with provider receipt of a discussion request within 3 days; and a requirement for recovery auditors to wait until the second level of appeal is exhausted before they receive their contingency fee.
CMS also will require recovery auditors to adjust the ADR limits in accordance with a provider’s denial rate, giving providers with low denial rates lower ADR limits and providers with high denial rates higher ADR limits. Additionally, CMS will establish new and revised ADR limits that will be diversified across different claim types, such as inpatient and outpatient, according to the NAAOP statement.