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September 13, 2011
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September 13, 2011

Recovery Audit Contractor Program

Overview

Recovery Audit Contractor Program

December 12, 2008

The Recovery Audit Contractor (RAC) initiative is a Centers for Medicare and Medicaid Services (CMS) initiative that began in 2005 as a demonstration project in three states including California. A permanent RAC program is begins in mid 2008.

Under the RAC program, private companies are contracted to retrospectively review Medicare claims for potential over-payments or under- payments.

CHA News Article

RAC Bill Gains California Co-Sponsors
Urge representatives to support H.R. 1250

Image of RAC Bill Gains California Co-Sponsors
May 17, 2013 Anne O'Rourke

CHA asks hospital leaders to contact their congressional representatives soon in support of the Medicare Audit Improvement Act of 2013 (H.R. 1250). The California delegation has continued to add co-sponsors to the legislation, but there is still time to add more. Today, Gretchen Case, director of compliance at Cedars-Sinai Medical Center, participated in a congressional staff briefing in Washington, D.C., about the legislation. Today’s briefing presents an opportunity for hospital leaders to now follow up with congressional staff on this important topic. For more information on the bill, see CHA’s March 21 Advocacy Alert at www.calhospital.org/support-changes-rac-program. Current California H.R. 1250 co-sponsors include Reps. Julia Brownley, Jim Costa, Susan Davis, Sam Farr, Jared Huffman, Doug LaMalfa, Barbara Lee, Zoe Lofgren, Alan Lowenthal, Buck McKeon, Devin Nunes, Ed Royce, Raul Ruiz, Adam Schiff, Jackie Speier, Loretta Sanchez and David Valadao.

CHA News Article

Hospitals Encouraged to Complete RAC Surveys This Week
Data helps to inform advocacy efforts for changes to the RAC program

April 17, 2013 Amber Ott Alyssa Keefe

In an effort to enhance advocacy efforts in the coming months, CHA reminds members to complete the American Hospital Association’s (AHA) RACTrac survey by the deadline of this Friday, April 19. RACTrac data will be used to analyze the impact of the Medicare Recovery Audit Contractor (RAC) program on hospitals and will help guide CHA’s advocacy for congressional action on legislation that, if enacted, would make important and necessary changes in the RAC program. AHA membership is not a requirement to participate in RACTrac; CHA encourages all hospitals to participate regardless of AHA membership status. For registration information, contact AHA’s RACTrac Support at (888) 722-8712 or ractracsupport@providercs.com.

CHA News Article

CMS Posts Temporary Instructions for Part B Inpatient Rebilling

April 12, 2013 Amber Ott

The Centers for Medicare & Medicaid Services (CMS) yesterday distributed the attached temporary instructions for providers to use in billing Medicare Part B services following denial of an inpatient admission. Last month CMS issued an administrative ruling and a proposed rule addressing the issue of Part B billing following the denial of a Part A inpatient hospital claim by a Medicare review contractor on the basis that the inpatient admission was determined not reasonable and necessary. The administrative ruling, which became effective immediately, will serve as CMS policy until the proposed rule is finalized. The temporary instructions apply to both Part B types of bills —12x and 13x — and include both electronic and paper submissions. CHA’s summary of the proposed rule is available at www.calhospital.org/sites/main/files/file-attachments/hpa_summary_of_cms_ruling_on_part_b_rebilling.pdf.

Regulatory Advisory

CMS Administrative Ruling, Proposed Rule Favor Hospitals in Updated Part B Inpatient Rebilling Policy

March 14, 2013 Alyssa Keefe Amber Ott Jana Du Bois

In a win for hospitals, the Centers for Medicare & Medicaid Services (CMS) issued the attached administrative ruling and a proposed rule updating the Part B inpatient rebilling policy. The administrative ruling acknowledges a number of recent decisions by the Medicare Appeals Council and administrative law judges and states that, effective March 13, when a Part A claim for a hospital inpatient admission is denied by a Medicare review contractor because the inpatient admission was not reasonable and necessary, the hospital may submit a Part B inpatient claim for services. The ruling applies as long as the denial was made: (1) while the ruling is in effect; (2) prior to March 13, and the timeframe to file an appeal has not expired; or (3) prior to March 13, and an appeal is pending. The ruling does not apply to Part A hospital inpatient claim denials if the timeframe to appeal expired prior to March 13, and it does not apply to inpatient admissions deemed by the hospital to be “not reasonable and necessary” (for example, through utilization review or other self-audit). Additional details regarding the time period for billing, scope of review, patient status and operational considerations are discussed in the ruling. The ruling will remain CMS policy until CMS has finalized its proposed rule, also released yesterday.

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