CHA News Article

CMS Releases Planned Changes to RAC Program
Current RAC contracts continued through 2015

The Centers for Medicare & Medicaid Services (CMS) has released the attached updates to the recovery audit contractor (RAC) program. Among the changes to the program, CMS will limit the RAC look-back period for patient status reviews to six months after the date of service if the hospital has submitted its claim within three months of the date of service. In addition, CMS notes that it will provide the RACs with 30 days — rather than 60 — to issue the review results letter. CMS also notes the changes will be effective with each new RAC contract. Notably, on Dec. 30 CMS awarded the durable medical equipment contract to Connolly LLC. CMS notes the new RAC contracts for Regions 1, 2 and 4 remain under “a pre-award protest,” which is expected to continue well into 2015. Therefore, CMS has extended the current RAC contracts, without the new improvements noted above, through 2015. CHA expects HDI, California’s RAC, to ramp up its efforts early this year. While the scope of the audits are not yet clear under these extended contracts, HDI had approval to proceed with all previously approved automated reviews and diagnosis-related group validations.  

CHA continues to work closely with the American Hospital Association to introduce federal legislation in the new Congress that would bring much-needed reforms to this program. Watch for a CHA advocacy alert in the coming weeks.