CMS Posts New FAQs on Medicare Recovery Audit Contractor Program

On December 2, 2008, the Centers for Medicare & Medicaid Services (CMS) posted 2 new Frequently Asked Questions (FAQs) and updated approximately 14 FAQs pertaining to the Medicare Recovery Audit Contractor (RAC) Program. As reflected on the CMS website, the 2 new FAQs are as follows:

Feedback

If I receive a demand letter from a Recovery Audit Contractor (RAC) because a service didn't meet Medicare's medical necessity criteria for an inpatient level of service, can we re-bill all the services on an outpatient claim?

Answer

Providers can re-bill for Inpatient Part B services, also known as ancillary services, but only for the services on the list in the Benefit Policy Manual.  That list can be found in Ch. 6, Section 10: http://www.cms.hhs.gov/manuals/Downloads/bp102c06.pdf.  Rebilling for any service will only be allowed if all claim processing rules and claim timeliness rules are met.  There are no exceptions to the rules in the national program.  The time limit for re-billing claims is 15-27 months from the date of service.  These normal timely filing rules can be found in the Claims Processing Manual, Chapter 1, Section 70: http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf.

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Will providers be required to submit a UB-92 with medical records to the Recovery Audit Contractors (RACs)?

Answer

The decision to request a UB-92 will be up to the individual RAC.  If this information is needed it will be notated on the medical record request letter.

As required by the Competition and Contracting Act of 1984 (CICA), CMS recently stopped work under the permanent RAC contract awards after 2 unsuccessful bidders (Viant, Inc. and PRG Schultz, USA, Inc.) filed protests with the U.S. Government Accountability Office (GAO). Under the CICA, the GAO has 100 days to issue its decision.