Tavenner Talks RAC
By Christine Kern, contributing writer
CMS assures hospital leaders of plans to fix RAC program, asks for feedback
Recently, Marilyn Tavenner, administrator of CMS, assured hospital administrators that CMS is actively seeking ways to improve the Medicare Recovery Audit Program.
Tavenner spoke at the Federation of American Hospitals annual meeting, telling attendees CMS has adopted a multi-pronged approach to address concerns with the RAC Program – which serves to identify improper Medicare payments – and that the agency is currently in the “beginning stages” of the procurement process for the next round of Recovery Audit Program contracts.
Health IT Outcomes previously reported CMS announced it would temporary suspend new audits in the current program to catch up with the auditing backlog and create a smooth transition, hopefully reducing provider confusion.
Modern Healthcare reported on Tavenner’s remarks about the CMS efforts to streamline the RAC program, stating that the pause in new audits would take “some period of months,” during which time CMS will refine and improve the program. Healthcare providers are optimistic this will mean fewer headaches for them, and argue the program to identify improper Medicare payments comes at a great expense and administrative burden to hospitals.
Tavenner said the CMS is considering and discussing several changes, such as making sure RAC auditors allow providers more time to respond to a denial. “At this point, we're looking at 30 days,” she said.
Another suggested change would mean that RACS could not receive contingency fees until the completion of the second level of appeal. The CMS also considering instituting a three-day window for acknowledgement of RAC receipt of records from a hospital during the audit process.
Tavenner requested feedback from the meeting's attendees, representatives of investor-owned or managed hospitals. She asked that they provide opinions not just on RAC but on other issues like the two-midnight rule, which directs Medicare's contractors to assume hospital admissions are reasonable and necessary for patients who stay in a hospital through two midnights.
Tavenner recognized the contributions of those in attendance, stating, “Our cost trends would not be where they are today without the work that you all have done. Our quality would certainly not be where it is today without the hard work inside each of your organizations. And so now I'm asking for your help in improving the RAC process and other areas that you think we can benefit from.”