The Centers for Medicare & Medicaid Services (CMS) recently updated the Recovery Audit Contractor/Overview page of its website to address CMS's phase-in strategy and clarify certain aspects of the Medicare Recovery Audit Contractor (RAC) program.
In particular, the updated page indicates that:
- CMS has not put a phase in strategy in place by provider type
- All provider types are available for RAC review once provider outreach has occurred in a state
- Any reviews completed by a RAC must have been first approved by CMS and posted to RAC websites
- CMS expects the first approved new issues to be posted in July 2009.
The updated page also addresses whether other claim types may be affected by a full inpatient denial and if the RACs will deny other claim types associated with the inpatient stay (e.g., physician evaluation and management services). With respect to that issue, the updated page states:
"At this time the RAC will not automatically deny claims that are associated with a full inpatient denial. However, these claims may be reviewed individually and there may be a need to fully/partially adjust the claim based on the documentation submitted."
