Protests Settled, CMS Resumes RAC Program Implementation
On October 6, 2008, the Centers for Medicare & Medicaid Services (CMS) announced the four contractors to implement the Recovery Audit Contractor (RAC) program:
- Region A — Diversified Collection Services, Inc. of Livermore, CA: initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York
- Region B — CGI Technologies and Solutions, Inc. of Fairfax, VA: initially working in Michigan, Indiana and Minnesota
- Region C — Connolly Consulting Associates, Inc. of Wilton, CT: initially working in South Carolina, Florida, Colorado and new Mexico
- Region D — HealthDataInsights, Inc. of Las Vegas, NV:, initially working In Montana, Wyoming, North Dakota, South Dakotas, Utah and Arizona
CMS announced in November 2008 that it was temporally delaying the RAC activities because two contractors who were not awarded the contract protested CMS’ decision. On February 6, 2009, the protests were settled and the implementation of the national RAC program has resumed. As negotiated in the settlement, the four RACs will contract with subcontractors to supplement their efforts:
- PRG-Schultz, Inc. will serve as a subcontractor to HDI, DCS and CGI in regions A, B and D.
- Viant Payment Systems, Inc. will serve as a subcontractor to Connolly Consulting in region C.
Each subcontractor has negotiated different responsibilities in each region, including some claim review.
In the next few months, CMS will meet with providers and medical societies on "provider outreach." Since the first face-to-face meeting between the two organizations in April 2008, the Society has communicated to CMS staff our concerns with the RAC process. In December 2008, CMS staff contacted the Heart Rhythm Society to ensure that the Society and CMS would meet again once this protest were settled.
The Heart Rhythm Society has been chosen to be among those provider associations to meet with the RAC staff overseeing the contractor’s work. The Society is also working with the American Hospital Association to agree on the guidelines (PDF, 70K) and to prepare electrophysiologists and their hospitals for these audits. Audits are to be fully implemented no later than 2010.
For more information, please visit the CMS website.
