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The RAConteurThe first and most obvious thing that my readers know about me is that my gender is male. I’m a guy, and while I’m not completely immersed in “guy things” in my off hours, there are a few exceptions. I like watching sports on TV, I drink beer (we’ll leave out the part about how much) and, as partly relates to today’s post, I like blowing things up with high grade fireworks. Give me a few M-80’s and anything inanimate (particularly stuffed animals) and we’re bound to have some fun. It is for this reason that this music video is one of my all-time favorites.
I haven’t been to any of the local fireworks stands of late, but that doesn’t exclude me from lighting a fuse. Last Wednesday, I wrote a post on the lack of provider outreach by the RAC contractors. I also wrote an abbreviated version of the same post for RACMonitor.com here. The response and residual fallout from these articles has been enlightening, to say the least.
First I’d like to give everyone an interim update. On the heels of the article appearing on RACMonitor.com, that publication’s Monday RAC webcast, Monitor Monday, put up a survey question regarding RAC provider outreach. The listeners had three choices: satified with my RAC’s outreach, not satisfied or “what outreach?”. Only 10% were satisfied, 34% were not satisfied and a whopping 56% have had no outreach at all. That represents 90% of people who express dissatisfaction with RAC provider outreach efforts, which, as a reminder, is part of their Statement of Work.
With these numbers for encouragement, I picked up where last week’s investigation left off.
To briefly encapsulate, when last I left you, I had sent e-mails to DCS, the Region A RAC and Connolly, the Region C RAC requesting schedules for upcoming provider outreach education sessions. I received a response from DCS asking for my provider NPI number so my request could be sent to the “correct area”. When I responded that I worked for a provider financial management company representing clients in New York and Connecticut, I received a response from the same person (she must have been the “correct area” all along) stating that DCS would be presenting a joint outreach webinar with NGS for providers in those states in February. I was also told that I should check the NGS website “later in 2011 or early 2012 for updates”.
That covered two of the eleven states under the DCS umbrella, so over the past week, I decided to go deeper. I went to the website of NHIC, the Jurisdiction 14 MAC covering the balance of the states of New England. Their education schedule ran only to the end of 2011, and included no upcoming sessions on RAC activities. A review of the website for Highmark Medicare Services, which represents the rest of the states in DCS’ universe, yielded identical results to NHIC.
To date, I have not received a response to my inquiry from Connolly, but I followed the lead I received from DCS and reviewed the websites of MACs within Region C. I began with Palmetto GBA for West Virginia, Virginia and the Carolinas, and found no upcoming education events. Next I reviewed Cahaba for Tennessee, Alabama, Georgia and (currently) Mississippi with similar results for the remainder of 2011. Pinnacle for Arkansas and Louisiana and First Coast Service Options for Florida had nothing related to RAC for the remainder of 2011. Trailblazers (representing the states in the Western portion of Region C) showed nothing thru January of 2012.
A quick review of MAC websites for carriers in RAC Regions B and D turned up one positive glimmer of hope. Noridian conducted a RAC workship this past Monday, but a review of the PowerPoint from the presentation indicated that the information was out-of-date, as there was no mention at all in the presentation of semi-automated review as a RAC method. Fortunately, there is an Ask-The-Contractor teleconference tomorrow that stars the Region D RAC and Noridian. Be sure to call 1-800-230-1951 before 1 PM CST, tell them I sent you and congratulate them for being an outlier.
Returning to a previous subject, the saga of Connolly doesn’t end there. On the heels of my article, I received a rather enlightening e-mail from a reader in a Trailblazers state. This person has a problematic issue that has been identified by Connolly as part of a RAC audit for which this person cannot get a resolution from either Connolly or Trailblazers. In a pyrrhic attempt at a solution, this person contacted Connolly and was told by a phone representative at Connolly that they don’t have to educate. I invite this week’s reading population to reread that last sentence and internalize it, then go have a Long Island Iced Tea and try to put it out of your mind.
Now let’s go back to the Fiscal Year 2010 Report to Congress on RAC Implementation that was released in late-September. On Page 9 of the report, a summary of the outreach efforts that CMS has undertaken appears, but mentions nothing about what the individual RACs have done to satisfy the education requirements as detailed in the RAC Statement of Work. It’s also worth nothing that the wording in the Report to Congress gives the distinct impression that CMS has completed their outreach efforts, save for occasional updates to their Frequently Asked Questions on the RAC program. In this context, a Connolly phone representative stating that they don’t have to educate the provider community should set off alarm bells.
To review, CMS has completed their outreach efforts, the RACs have either nothing scheduled or have yet to update the education calendars on their websites and a majority of the MACs will get to it next year, if at all (after all, what’s the rush?). Meanwhile, all the provider community requests is feedback and guidance, and instead are mostly left needlessly in the dark.
Now that we’ve squeezed the life out of the topic of outreach, I’ll end with an important update. I was sent this link by reader Sue Ann Jantz of Cottonwood Pediatrics in Newton, Kansas. HMS Holdings Corp., the parent company of HMS, announced this past Monday that it had acquired Health Data Insights, the Region D RAC, for $400 million. HMS will now take over all of HDI’s RAC activity, which if you remember also includes the Medicaid RAC contract for Kansas. I did get one good laugh when HMS stated in the announcement that HDI had the best “accuracy score”, as well as the highest collections. If the ridiculously inflated scores for all four RACs meant anything at all, this would be a statement worth making. Provider experience to date shows them to be meaningless.
As we welcome HMS into Region D, let me begin by stating that we hope that you will concentrate as hard on provider outreach as you will on Region D’s affect on the corporate bottom line.
I shall be appearing on Monitor Monday on November 14th at 9 AM CST. A link to sign up to this webcast can be found here.
In Region B, NGS (the MAC) did imbed some RAC education in what was billed as their 2011 Part A Live and In Person Seminar. This is/was a road show which is/was done in Indiana, Illinois and Michigan during Oct-Dec. The RAC education was buried in a session on Section 935 Limitation on Recoupment. There were 4-10 slides in the presentation specific to RAC, but in general was about recoupments, limitations on recoupment and appeals of all kinds for Medicare.
But, as you mentioned, we haven’t heard from CGI, except for their limited participation in the call that was initiated by AHA at the beginning of this month.
[...] past postings in this space, I have touched on the lack of useful provider outreach on the RAC program. This [...]