Home Health & Hospice Week

But RACs may be having less overall effect than you'd think. A new Government Accountability Office report criticizes the Centers for Medicare & Medicaid Services for failing to take action to address program vulnerabilities discovered by RAC probes.

"CMS has not yet implemented corrective actions for 60 percent of the most significant RACidentified vulnerabilities that led to improper payments," the GAO says. That includes mistakes that led to $500,000 in improper DME payments.

"The agency did not develop a plan to take corrective action or implement sufficient monitoring, oversight, and control activities to ensure these significant vulnerabilities were addressed" in the RAC pilot, the GAO continues. The same problems have persisted in the permanent national RAC program.

Don't expect those problems to continue, though, CMS says in its response to the GAO report. CMS is planning on cracking down on billing problems brought to light by RAC audits.

CMS has created a RAC response team that will identify vulnerabilities and refer them to the appropriate CMS personnel, the agency says in its official comments. And contractors are conducting pre-pay review, updating Local Coverage Decisions, and installing local edits in response to RAC findings, CMS adds.

Not so fast: CMS often won't take action until the claims have made it through the Medicare appeals process, the agency cautions. "It is necessary to wait for the appeals process to be completed to ensure the identification was accurate and appropriate," CMS maintains.

The GAO report is at www.gao.gov/new.items/d10143.pdf.