When it comes to government publications, I have come to believe that the main purpose of any given release is to communicate absolutely nothing using as many words as is humanly possible.
As one example, I present you with this link to a “pamphlet” put out by the Texas Department of Public Safety as a guide for trucking firms. The first question that pops up in my mind is what pamphlet any of us have seen (prior to today) that clocked in at 171 pages. I can sum up the entire pamphlet in 28 words: get a trucker’s license, don’t use drugs or alcohol, careful how you move toxic substances, don’t fall asleep and the state will check on all of the above.
Late yesterday, I received an e-mail from CMS about another such publication that falls under my area of interest. Found at this particular link is the Fiscal Year 2010 report to Congress regarding the implementation of the RAC program.
Let’s talk for a moment about the timing of the release of this 39-page report. Today is the last day of Fiscal Year 2011, meaning that this report is being released a year after the fact. The way I see it, the data from the report that I am about to relate to the reader has already been superseded by information that the government has yet to compile. Any seemingly positive news in this report, when placed in this context, is akin to a waiter in the dining room of a sinking Titanic bragging about the quality of the silverware. We were hoping to hear more about the lifeboats, and we all kind of lost our urge for a sit-down dinner when the ship hit the iceberg.
The fact that this report is late is another in a continuing and disturbing pattern of CMS not releasing vital data on a timely basis. The Fiscal Year 2010 CERT report, as of this moment, has not been released, with the 2009 report having been released almost 20 months ago. In addition, tomorrow is the first day of Fiscal Year 2012, and the OIG has not yet released their Work Plan for the next 12 months. Picture the movie Planet of the Apes being reshot with none of the actors wearing ape makeup and you begin to understand the effects of the absence of this particular report on the provider community.
Now that we’ve tackled the preliminaries, let’s take a look at the outdated nonsense entombed in this report. Pages 3 and 4 provide us with an overview of the need for the RAC program, which can be best distilled into the phrase “the MACs don’t know what they’re doing”. Page 5 relates the financial results of the first year of the program as a window into ancient history. This information was made available on April 26th of this year, but there’s nothing a government publication loves so much as repetition. For the record, again, the RACs identified $92.3 million in improper payments in FY 2010, with 82% of that total reflecting overpayments.
Pages 6 thru 18 repeat everything we’ve been taught about the RAC program to date, from the need for the program, their methodologies, the appeals process and steps taken to ensure accuracy, transparency and minimal provider burden. Pardon me as I take the time to clean up the unsweetened iced tea that just came out of my nose as I typed the final three words of the previous sentence.
Page 19 gives us the first “fresh” information in the report, that being the first numbers regarding appeals of overpayment determinations. As is indicated in a footnote on this page, because the full appeals process for providers can take up to two years, the following numbers aren’t final, but they are revealing nonetheless. In all, 8,449 claims (5 percent of all overpayments identified by the RACs) have been appealed. Out of that number, 3,902 claims were ruled in the provider’s favor. This represents a preliminary provider success rate on appeal of 46.2%.
To date, we have only had hints about the RAC learning curve with regard to review determinations, and when compared to the latest AHA RACTrac report, the success rate seems low, but it is still inflated. Imagine for a moment that 20% of all RAC overpayment determinations were appealed by providers. The RAC program would evolve from a major time-wasting exhibition of paper-shuffling to an epic time wasting exhibition of paper-shuffling.
Page 20 shows the top issues being identified for improper payment by the RACs, which have been detailed in previous quarterly reports, and continue to evolve. Pages 22 and 23 are dedicated to examples of corrective actions and continuous improvements being undertaken by the program. I would have hoped that these sections were somewhat larger, but one can dream.
Pages 24 thru 39 feature a series of appendices that show the hard numbers for all of the word salad in the previous portions of the report. For my purposes, I skipped right to page 38, which showed the appeal rates by contractor. If you are a provider in Region B under CGI, which happens to be my little corner of the world, it would benefit you greatly to cast doubt on any and all RAC determinations, as 60% of all appealed overpayment determinations are overturned in the provider’s favor. Sadly, only 18.2% of all of CGI’s overpayment determinations were appealed through last September 30th, meaning that CGI’s statistically demonstrated incompetence is being allowed to let slide by the provider community.
Page 39 is what I summise to be CMS’ version of absurdist comedy. For some time I’ve spoken about the fact that the RACs are assigned an accuracy score, on a scale of 1 thru 100, by the RAC Validation Contractor (RVC) based on a random audit of sampled claims from each contractor. CMS, thru its program managers, is not shy about communicating that a low score jeopardizes a RAC contractor’s continued participation in the program.
Now, review again my paragraph about CGI’s abysmal rate of overturned claims on appeal. Having done that, now try to convince me how that contractor earned a cumulative accuracy score of 99.2 by the RVC. I invite you all to review the remainder of Appendix F of this report – using the previous sentence as a beachhead – if the Marx Brothers classic Duck Soup isn’t showing on cable this week, as both the appendix table and the film are overtly silly and have similar affects on your mood.
We have all waited months for some glimmer of measurement of the RACs and their performance. If this report is being released as an exercise in chest beating by CMS regarding the “success” of the recovery program, I would invite those who drafted the report to refer to the Webster’s definition of that word for clarification. This report illustrates a number of oft-repeated ideas and beliefs, but success is hard to find among its pages.