August 29, 2014

On August 4, 2014, the Centers for Medicare and Medicaid Services (CMS) announced that it would allow the Recovery Audit Contractor Program (RAC) to resume a limited number of reviews in August. The program has been dormant since the current RAC contracts expired June 1. CMS stated that the program has experienced continued delay in beginning modifications to the current contracts. CMS additionally noted that there will be no inpatient status reviews during this restart period.

Furthermore, most reviews beginning in August will be done on an automated basis, which does not require the analysis of a medical record. RACs will only perform complex reviews on a limited number of claims including spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures. Additionally, CMS stated that it “remains hopeful” that the new round of RAC contracts will be awarded this year.

To read the full alert, click here.