Home Health & Hospice Week

Recent delays give you more time to plan for these audits.

If you've been ignoring RACs because Medicare contractors have largely overlooked home care topics, it's time to pay attention.

Get ready for a whole new wave of recovery audit contractor audits, thanks to last year's Patient Protection and Affordable Care Act and its requirement for Medicaid RACs. In place for Medicare contractors since 2005, RACs are often referred to as medical "bounty hunters" because they make money only if they collect overpayments from you. Their income is specifically tied to the amount they recover, and is based on a percentage of the overpayments they identify.

Medicare RACs have investigated only a small number of topics tangentially related to home care and hospice, including "DME while in Hos-pice," "Hospice Related Services -- B," and "Medi-cal Supplies and Home Health Consolidated Billing" (see Eli's HCW, Vol. XIX, No. 9, p. 66). Medicare RACs also have targeted about two dozen DME topics for review.

Now the RAC program is coming to Medi-caid, and the states may take a bigger interest in home care. "Medicaid RACs are tasked with identifying and recovering Medicaid overpayments and identifying underpayments," the Centers for Medi-care & Medicaid Services website notes. Last Oc-tober, the agency sent a letter to each state's Medi-caid director informing them of the RAC audit specifications.

"The Medicaid agencies may require the Medicaid RACs to target a broader spectrum of providers," forecasts attorney Robert Markette Jr. with Gilliland & Markette in Indianapolis. "If they are going to implement a RAC program, they most likely will want to see it targeting all providers."

Initially, Medicaid RACs were supposed to be in place by April 1 of this year, but that deadline has been extended, says attorney Mark W. Bina with Krieg DeVault in Chicago. "Most states were unable to meet [the April 1] deadline because of various budgetary and operational hurdles," Bina says. "On Feb. 1, CMS announced the deadline would be pushed back indefinitely."

The new implementation deadline has not yet been set but will be identified in a final rule to be published later in 2011, Bina adds.

But the delay shouldn't let you ignore RACs. "The bottom line is that ... a state's Medicaid RAC program represents more auditing resources being brought to bear on Medicaid providers," Markette tells Eli. "Home care providers should be prepared for an increase in audit activity."

Prepare: Providers should be auditing and monitoring themselves to make sure they don't have any claims issues or related compliance billing problems, Markette counsels. "Now more than ever, providers need to be preventing billing mistakes and also identifying and correcting mistakes they have already made."

And it's a good idea to brush up on RAC facts before the audits hit, experts suggest. For example, if a RAC indicates to you that an audit is imminent, you'll want to find out the deadline by which you're required to submit any requested records, as well as the audit's point of contact.

Appeals: RAC determinations are not the final say regarding whether you'll owe money. State Medicaid programs must have appeal processes in case you disagree with a RAC's findings.

"Under the Proposed Rule related to the Medicaid RAC program, CMS proposed to permit states the 'flexibility to determine the appeals process that would be available to providers who seek review of adverse RAC determinations,'" says attorney Jessica L. Gustafson with The Health Law Partners in Southfield, Mich. "Significantly, this means that the appeals process will likely differ from state to state," she adds. v

Note: CMS's Medicaid RAC letter is at http://www.cms.gov/smdl/downloads/SMD10021.pdf.