RAC Assistance for Hospice is a service provided by Weatherbee Resources to help hospices deal with Recovery Audit Contractor (RAC) scrutiny and to monitor and assess the impact of the RACs on hospices across the country.
One feature of RAC Assistance for Hospice is an e-Newsletter, published in collaboration with Tim Rowan of Home Health News, providing timely information, specific to hospices, regarding RAC activities and issues as they emerge. Since we don’t yet know how significant the impact of the RACs will be, our goal is to use this interim period of time to help hospices position themselves so they are ready for whatever scrutiny the RACs may bring.
Our strategy is simple: P-E-M (Prepare -Educate - Manage). This approach to the RACs, developed by Weatherbee Resources, will focus on the following:
Prepare - conduct a baseline compliance audit to assess levels of risk
Educate - learn everything possible about the RACs and what they do; intensify training to clinicians on documenting patient eligibility; and
Manage - develop a comprehensive management response to the RACs.
Please join us by clicking here to subscribe to the RAC Assistance for Hospice e-Newsletter and participate in the RAC Forum to help us monitor RAC activity and do what we can, together, to minimize the RAC threat to the financial viability of hospices.
CMS provided a one and a half hour RAC 101 teleconference to hospice and home health providers on May 4th. It became apparent quite quickly that although the teleconference was provided for hospice and home health, the information presented was generic to all providers. The slide presentation (click here to view) contained basic RAC information to give an overview of the history and goals of the RAC program as well as how it works.
The most interesting part of the teleconference was the question / answer period which lasted almost a full hour. During the Q & A it Read the rest of this entry »
CMS has announced that it will be providing a series of RAC 101 conference calls presented by CMS staff. These conference calls will be similar to the outreach sessions provided prior to the RAC roll out last year and the content is likely to be the same as the recently posted CMS RAC 101 presentation on You Tube (click here to see it). However, each call will have a question / answer session which is a good opportunity to get clarification on certain issues. The call for hospice and home health providers is scheduled for May 4th from 1:00 to 2:30 PM EST. No registration is necessary. To join the call dial 1-877-251-0301, meeting ID: 66524952. For more information about these calls, click here.
The Office of the Inspector General (OIG) issued a report in February 2010 called Recovery Audit Contractors’ Fraud Referrals. The purpose of the report was to conduct an in-depth study of: 1) the extent to which RACs referred instances of potential fraud to CMS during the three year demonstration and 2) the extent to which CMS provided training to the demonstration RACs and the permanent RACs regarding identifying and referring potential fraud. The results of the report indicate, more than anything, that the OIG wants the RACs to step up their fraud referrals. Read the rest of this entry »
On March 10, 2010, President Obama issued a memorandum to all heads of executive departments and agencies regarding finding and recapturing improper payments. As part of continuing efforts to combat fraud, waste and abuse throughout the government, President Obama is expanding the the use of “Payment Recapture Audits.” Payment recapture audits are what recovery audit contractors (RACs) do to earn their contingency fees. Read the rest of this entry »
The last RAC Assistance for Hospice Newsletter alerted hospices to the fact that HealthDataInsights, the RAC for Region D, has received approval from CMS to review two hospice-related issues. Given that we are all new at this and don’t know how it will impact hospices, here are some thoughts… Read the rest of this entry »
HealthDataInsights (HDI), the RAC for Region D, has posted two approved issues related to hospice. RACs must submit an issue to CMS for approval before it can conduct an automated (without a medical record) or complex (with a medical record) review. CMS has approved two issues related to hospice for HDI to begin reviewing in all of the states in Region D
It is the end of the year. It is the end of the first decade of this not so new anymore century. We can’t resist the temptation to make a list of the Top Ten Hospice Regulatory Challenges of the Past Ten Years. Here they are - in no particular order: Read the rest of this entry »
The Patient Protection and Affordable Care Act (aka the health care reform bill currently under consideration by the Senate) has implications for the RACs. Of most relevance in this 2074 page bill is Section 6411 which seeks to expand RACs to Medicare Parts C and D by 12/31/2010. The RAC program would also be expanded to Medicaid. Read the rest of this entry »
Now is a good time to determine your hospice’s level of risk exposure to overpayment recoupment from your RAC.Although the RACs have not kicked in yet and may not for several more months, conducting an assessment now can give you a better sense of how vulnerable your hospice might be and how much you need or do not need to be worrying about the RACs. It can also help in the ongoing challenge of safeguarding against ADR claim denials and unsuccessful appeals.Read the rest of this entry »
You do not need to be afraid of the RACs.Making certain that your hospice can withstand whatever RAC scrutiny may come your way is not as hard as it may seem at times.The RACs are not yet targeting hospices and there is an opportunity NOW to make certain that each and every claim submitted for payment is for care provided to patients that are eligible for hospice and/or for the level of care provided. Read the rest of this entry »
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