This week, National Government Services (FI/MAC) and Performant Recovery Inc. (RAC), held two webinars to introduce themselves and explain the Recovery Audit process to Providers. The RAC Regions were re-aligned as a result of the new Recovery Audit Contractor contracts and work is scheduled to resume this quarter for Performant, prompting a re-introduction.
The webinars served to educate Providers on the key characteristics of the new RAC contracts and the scope of the RAC Regions while highlighting key timeframes and RAC processes. They also reviewed the RAC resources available and conducted a Q&A session.
- Performant expects to send out the next round of ADRs this March
- CMS calculates the ADR limits on Providers, not the RACs. Performant will be using the baseline annual ADR limit set by CMS, which is one-half of one percent (0.5%) of the Provider’s total number of paid Medicare claims from a previous 12-month period. The baseline annual ADR limit allows for a 3-year look back period from the claim paid date
- ADR limits must be diversified across all claim types of a facility, based on the Types of Bill (TOB) that the Provider was paid for in the previous year
- Providers must send one, complete submission of records in response to the ADR letter as the audit timeframe begins upon receipt of any record related to the review. Performant asks that Providers not send multiple submissions of records. Providers may contact Performant’s Customer Service to request an extension, rather than sending multiple submissions of records
- Providers have 30 calendar days from the date of the Review Results letter to submit a request for a Discussion Period. The Discussion Period provides an opportunity for Providers to submit additional documentation if they disagree with the review determination. RAC takes into consideration additional information, re-audits the account and either upholds or overturns the original decision. If the audit is overturned in the Provider’s favor, the audit is closed and no adjustment is sent to the MAC
- Providers must initiate the request for a Discussion Period. The Discussion Period request form is posted on Performant’s website: https://www.performantrac.com/FormsandSampleDocs.aspx. Providers can request a Physician-to-Physician discussion which will be performed via teleconference. However, Performant states, “a physician employed by the Provider does not include those Providers employed as consultants”
- RACs are not performing status reviews at this time, but they may still receive QIO referrals regarding short stays (which are limited to a 6 month look back period)
Cain Health will continue to monitor the work being conducted by the RACs and provide updates as soon as they are available.