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Trending in Healthcare - November 2016

 

CMS Announces New RAC Contractors

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On Monday, October 31, 2016, the Centers for Medicare and Medicaid Services (CMS) announced the new Recovery Audit Contractors (RACs) for Medicare fee-for-service.

Region 1 – Performant Recovery, Inc.
Region 2 – Cotiviti, LLC
Region 3 – Cotiviti, LLC
Region 4 – HMS Federal Solutions
Region 5 – Performant Recovery, Inc.

Cotiviti, previously called Connolly, will take over the regions previously served by CGI. Make sure your staff is aware of the new contactors, in order to route any correspondence to the appropriate individuals in a timely manner. Please note that, historically, contractors who have bid but not received contracts have filed protests resulting in implementation delays.

According to CMS, Regions 1-4 will be performing post-payment reviews for all provider types except home health, hospice and durable medical equipment (Prosthetics, Orthotics, and Supplies (DMEPOS) which will be reviewed by Region 5. We expect CMS to publish more information about the implementation of the new contractors in the near future.

Before sending any medical records to a Recovery Auditor, it is important to have them reviewed for completeness and accuracy by an experienced and qualified clinician. Contact your trusted Marcum advisor to learn more about how our clinical team can help prepare your records for medical review.

 
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