News: CMS highlights actions to reduce RAC-related complaints and appeals

In a recent blog post, CMS Administrator Seema Verma highlighted progress in reducing provider complaints related to the Medicare Recovery Audit Contractor (RAC) program and the associated backlog of appeals, AHA News reported.

Last November, a trial court judge ruled that the Department of Health and Human Services (HHS) must eliminate the backlog of more than 426,000 appeals by 2022. According to Verma, HHS has taken significant steps toward this goal including the following:

• Better oversight of RACs by
  
  • Requiring a 95% accuracy score
  • Requiring that they maintain an overturn rate of less than 10%
  • Eliminating any contingency fees to the RAC until after the second level of appeal is exhausted
• Reducing provider burden and appeals by
  
  • Requiring RACs to audit proportionately to the types of claims a provider submits, rather than allowing RACs to select certain types of claims for audits
  • Conducting fewer audits for providers with low claims denial rates
  • Allowing the provider 30 days after an improper payment is identified to provide additional documentation
• Increasing program transparency by
  
  • Regularly seeking public comment on proposed RAC review areas before reviews begin
  • Requiring RACs to enhance their provider portals to make it easier to understand the status of claims

Though Verma says that the state of affairs is improving, in fiscal year (FY) 2019, the average processing time for appeals increased from 1,193.9 days in FY 2018 to 1,321.1 days in FY 2019, according to Rev Cycle Intelligence, indicating there is still work to be done.

Editor’s note: To read the Blog post from Verma, click here. To read AHA News’ coverage of this story, click here. To read Rev Cycle Intelligence’s coverage, click here. To read about the court order mandating the backlog be cleared, click here.