CHA News Article

CMS Announces Improvements in RAC Program

The Centers for Medicare & Medicaid Services (CMS) has announced a pause in operations for the Recovery Audit Contractor (RAC) program until the end of the current procurement process for the next round of RAC contracts. RACs may not send a post-payment additional document request (ADR) after Feb. 21. CMS has also announced a number of improvements to the RAC program in response to industry feedback. The changes, attached, include revised ADR limits that will be diversified across claim types; ADR limits adjusted in accordance with a provider’s denial rate; and contingency fees not paid to RACs until the second level of appeal has been exhausted. In addition, providers will no longer have to choose between initiating a discussion and an appeal, and RACs must confirm receipt of a discussion request within three days. CHA is pleased with the direction of CMS’ changes but urges that more be done to relieve the burden on hospitals. CHA continues to support the Medicare Audit Improvement Act of 2013 (H.R. 1250/S.1012) in the House and Senate.