CMS has made an audio recording of the call availableHERE (MP3 file access - not downloadable)
CMS held an audio conference call on April 8, 2009, as one of their Special Open Door Forums, for Part A providers, to introduce them to the new Recovery Audit Contractors (RACs), and to provide information on RAC operations and procedures. The call included some important new information, including the addresses for two new websites from the RACs themselves.
This is the first such call conducted by CMS since the permanent RAC Program was allowed to go forward after a legal challenge by prospective contractors delayed the program start, from November 2008 to February 2009.
News in Several Major Topics
If you are already familiar with the program, you might not need to read or listen to the whole call. Regardless, we want to call your attention to some items that appear to be new, or at least there are some new details we have not seen before in any RAC documents or outreach sessions.
Several topics are of high importance for all providers:
a special code will be used on Remittance Advice documents to help providers track RAC denials;
a Discussion Period exists, providing an opportunity to avoid a denial and appeal;
Records Request Limits have changed, will continue to change, and the rules for applying the limits are still confusing;
a “limited number” of Complex Reviews can begin without CMS approval;
providers are being encouraged to directly contact CMS project officers;
RAC websites are beginning to appear, (2 of 4 anyway);
and last but certainly not least,Medical Necessity guidelines, such as InterQual and Milliman, will only be guidelines for the RACs.
This last topic is one of the scariest topics for all providers.
We are publishing a special analysis of the new information on the RAC Monitor website - the article will appear in two parts. We will also post it here, as well.
