Medicare Compliance & Reimbursement

CMS will try to contact providers when it sends letters.

Given the high non-response rate to the Comprehensive Error Rate Testing contractor, many providers are worried that they'll accidentally miss a letter from the recovery audit contractor and be hit with an overpayment, said Jean Acevedo with Acevedo Consulting in Delray Beach, FL.
 
The Centers for Medicare and Medicaid Services said the RAC letters will look like carrier audit letters, and the RACs may go the extra mile to contact people. CMS hopes the RACs will do a better job than the CERT contractor of obtaining the most accurate contact information for providers. But it may also be worthwhile to notify the RACs in advance of a particular staff member or address that they should send correspondence to, CMS noted. That way, the RAC letters won't get lost in the shuffle.

Physicians are frightened and overwhelmed by the prospect of another set of contractors, Acevedo reported. "I can't tell you how many very fine physicians are thinking of going [non-participating] or opting out. This is like the last straw," she said.

One physician calling into the forum questioned how much medical expertise the RAC staff would have in coping with tricky questions such as surgical global periods and medical necessity. Melanie Combs with CMS responded that the RACs will mostly have nurses reviewing claims.

Another cause for concern: the RACs will be using their own proprietary software that physicians fear is designed to limit their payments, not impose correct coding. But CMS officials insisted the software will be tailored to Medicare's rules.

If the RAC decides all or part of a claim payment was an overpayment, it will issue an overpayment demand letter directly. Previously, CMS had said the overpayment demand would go through a provider's usual intermediary or carrier. Providers and reps also worried that CMS isn't getting the word out on who the RACs are, so providers won't send in their medical records as required.