CMS releases updated RAC Statement of Work

CDI Strategies - Volume 5, Issue 18

CMS updated its Recovery Audit Contractor Statement of Work (SOW), according to an article in AHA News Now. The new SOW calls on RACs to review all Medicare claim-types and types of providers. It also asks RACs to increase semi-automated reviews which allows the contractors to ask providers for additional information prior to issuing perhaps unwarranted automated denials.

The SOW also requires better organization of RAC websites; more appropriate notification of the reasons for denials; and a guaranteed RAC discussion period for all claim denials, giving providers an opportunity to reverse denial decisions without entering the formal appeals process, according to AHA News Now.
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Quality & Regulatory