In the United States, we have a serious problem with customer service assistance. Currently, I’m fighting a fee that was recently charged to a Dollar rental car and getting limited help. If you watch TV, you are familiar with the series of commercials for a major credit card company where a male, bearded East bloc customer service representative named “Peggy” pulls out every excuse possible in order to hang up on the customer in record time. The eternal question still reigns supreme: “Where’s good help when you need it?”.

I offer for my reading populace another example.

Since the beginning of the permanent Recovery Audit program, the four RA contractors have been mandated to perform provider outreach to “notify provider communities of the recovery auditor’s purpose and direction”, according to the RAC Statement of Work (SOW), which was updated in September.

The SOW details how the RACs submit a baseline provider outreach plan to CMS. CMS uses the plan as a starting point for discussion, which would lead to a more detailed plan, which should include “potential outreach efforts to associations, providers, Medicare contractors and any other applicable Medicare stakeholders”.

On a hunch (that hunch being that provider outreach has come to a grinding halt), I decided to look into the efforts of the contractors in this area. I started my informal Columbo-like investigation at the RAC website level. The first roadblock I encountered was that DCS and Connolly, the Region A & C RACs, respectively, do not have an education schedule on their websites. I snapped into action immediately and sent out e-mails to each RAC for clarification. I’ll provide more on the results of those communications later in this posting.

CGI, the Region B RAC, does have their schedule of all conducted outreach sessions on their dedicated RAC website. The last provider outreach session from CGI occurred on March 24^th of this year in Illinois. Being from Wisconsin, I was particularly interested in the fact that in my state, only three sessions have ever taken place. To add insult to the injury of ignorance, none of these three sessions were aimed directly at facilities or physicians.

HDI, the Region D RAC, doesn’t make their list of outreach meetings easy to find, but after some fancy clicking of links, I came across this page on their website, which lists all of the outreach conducted thus far by HDI. As it indicates, the last outreach session for Region D providers occurred in September of 2009.

To get a mental picture of what this outreach vacuum means for the provider community, it helps to compare the outreach schedules of these two contractors with the number of approved issues added by each RAC over the same period where outreach education didn’t occur. In Region D, 336 of their 386 approved issues have been added since their last provider outreach session. In Region B, 53 new issues have been added since March 24^th, with 43 of these issues being complex.

While I was exploring these assorted bits of ancient history, I received an e-mail from a customer service representative at DCS stating that an outreach webinar will be conducted jointly with NGS for providers in New York and Connecticut in February 2012. Using this as a lead, I checked the education schedules for MACs in each region, and to date, I see no webinars or other outreach events related to RACs on their calendars. I invite the reader to do a more thorough investigation. As a footnote, I had yet to receive a reply from Connolly at the time I published this post.

While many larger organizations have taken to discussing RAC issues as a group in search of enlightenment, it would appear that the RACs are in violation of  their work order. In the SOW, the Recovery Auditors are tasked with submitting monthly progress reports to CMS that outline all work accomplished during the previous month. The report is supposed to include upcoming provider outreach efforts, but perhaps CMS is so busy dissecting the appalling appeal statistics that they have been skimming over this section.

When the RAC in charge of the most densely populated state in the country has produced 87% of its approved issues list without presenting outreach to providers in its region, I would argue that it is indicative of a problem. Hospitals at this point know the ins and outs of the program, but I continue to encounter physician groups across the country that have only passing knowledge of the RAC program. Many that I encounter have no knowledge of RACs at all. CMS asks a lot from the provider community with regard to compliance. Perhaps the time has arrived for physicians to request that CMS and their contractors return the favor with a little shared knowledge.

Tags: CGI / Connolly / DCS / HDI / MAC / Outreach Education / RAC / Recovery Audit Contractors / Statement of Work
12:30 pm, November 2nd, 2011 |