Recovery Audit Contractors that exceed the 60-day limit to review records are subject to weak penalties that RACs can easily ignore, according to a blog by J. Paul Spencer at Fi-Med.
Responding to an inquiry on this from a provider, CMS said exceeding the time limit "may result in assessment of a lower score in their annual performance appraisal," which "impacts CMS’s determination of whether to extend the incumbent RAC’s contract for an additional year."
"With this type of lack of accountability," Mr. Spencer said, "the solution to this falls upon the provider community."
He advised hospital RAC teams to carefully track the time RACs take to complete a complex review, even contacting RACs after records have been sent to them to determine the date of receipt. Then, if more than 60 days elapses and there is a determination for overpayment, hospitals should appeal the claim based on failure to meet the deadline.
An appeal is "certain to get the RAC’s attention if a large number of cases are appealed for this reason," Mr. Spencer said. He also suggested reporting a RAC’s tardiness to CMS.
Read Mr. Spencer's blog on RACs.
Find out more about RACs:
- Hospitals in RAC Region B Most Successful in Appealing Denials
- 4 Ways Medicaid RACs Could Differ From Medicare RACs
- 3 Ways RAC Audits Differ From Previous Medicare Audits
Responding to an inquiry on this from a provider, CMS said exceeding the time limit "may result in assessment of a lower score in their annual performance appraisal," which "impacts CMS’s determination of whether to extend the incumbent RAC’s contract for an additional year."
"With this type of lack of accountability," Mr. Spencer said, "the solution to this falls upon the provider community."
He advised hospital RAC teams to carefully track the time RACs take to complete a complex review, even contacting RACs after records have been sent to them to determine the date of receipt. Then, if more than 60 days elapses and there is a determination for overpayment, hospitals should appeal the claim based on failure to meet the deadline.
An appeal is "certain to get the RAC’s attention if a large number of cases are appealed for this reason," Mr. Spencer said. He also suggested reporting a RAC’s tardiness to CMS.
Read Mr. Spencer's blog on RACs.
Find out more about RACs:
- Hospitals in RAC Region B Most Successful in Appealing Denials
- 4 Ways Medicaid RACs Could Differ From Medicare RACs
- 3 Ways RAC Audits Differ From Previous Medicare Audits