The Centers for Medicare and Medicaid Services awarded five contracts to three new collection agencies on October 31 and they are just about ready to begin to examine your claims and documents, looking for overpayments and underpayments.
The contractors are (full contact details below):
Region 1 – Performant Recovery, Inc.
Region 2 – Cotiviti, LLC
Region 3 – Cotiviti, LLC
Region 4 – HMS Federal Solutions
Region 5 – Performant Recovery, Inc.
If you are still wrestling with overpayment accusations from a previous RAC investigation, you will continue to deal with that legacy collection agency. CMS stated that their original Medicare FFS RACs will be under contract with CMS until 2018 for administrative purposes. Providers may still receive correspondence related to claims adjusted under the original RAC contracts.
From the CMS announcement
Mission - The Medicare Fee for Service (FFS) Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.
Background - The Medicare FFS Recovery Audit Program began as a demonstration required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The demonstration was conducted from March 2005 to March 2008 in six states to determine if Recovery Auditors could effectively be used to identify improper payments for claims paid under Medicare Part A and B.
This demonstration allowed for additional review of Medicare claims for payment by utilizing Recovery Auditors on a contingency fee basis to identify and investigate claims with calculated risk. The demonstration established Recovery Auditors as a successful tool in the identification and prevention of improper Medicare payments. Section 1893(h) of the Social Security Act authorized the Recovery Audit Program expansion nationwide by January 2010.
Only one RAC for HHAs
The RACs in Regions 1-4 will perform postpayment review to identify and correct Medicare claims that contain improper payments (overpayments or underpayments) that were made under Part A and Part B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice.
The Region 5 RAC will be dedicated to the postpayment review of DMEPOS and Home Health/Hospice claims nationally. Region 5 contractor, Performant, will conduct a webinar on March 21 for Home Health and Hospice providers. Click here for further information.
Medicare Fee For Service RAC Contact Information
Region 4: HMS Federal Solutions
Region 5: Performant Recovery, Inc.
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