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The RAConteurLast Wednesday in this space, I shared information with my reading audience pre-emptively from a provider outreach presentation from CGI, the Region B RAC, that took place one day later at a meeting of health care financial professionals in the State of Wisconsin.
Before I do my level best to attempt to erase all memories from last week’s posting, let me start by saying that I grew up in an urban environment. I say this because I want everyone to know that I’m not a fan of camping. Having never started a literal or figurative fire before in my life, I’m not particularly well-versed in controlling a conflagration before it takes out the surrounding trees. I have come to believe that the biggest part of the survival instinct is knowing where you don’t belong and seeing that you never arrive there.
In the realm of accuracy, last week’s post might as well have been a wicker man soaked in gasoline dancing in dry brush.
As many readers almost immediately pointed out, the data supplied in last week’s posting, which was taken directly from a CGI PowerPoint presentation, was about as accurate as Kim Jong Il’s state-sanctioned official biography. While I have already posted the corrected information on a Google group board dedicated to RAC issues, I shall repeat them here for everyone’s benefit.
The original information posted stated that there had been only 7,919 audits conducted through December of 2011, with only 5 yielding no findings. The correct number of audits completed is actually 23, 594, with 17,984 of these lacking findings. For the math challenged, that represents an increase in lack of findings from the original number of nearly 3600%, or as Bob Uecker put it in the movie Major League, “Juuuuust a bit outside”. Of note is the fact that over 22,000 of the claims reviewed thus far have been for inpatient services, but this too was patently obvious to those who have had the most interaction with CGI in Wisconsin.
With regard to discussion periods, CGI’s original number of 502 discussions requested was actually revised downward to 216. According to my source in attendance, when CGI presented this number at last Thursday’s session, they followed it up by saying that 200 discussions were “affirmed” while 8 were “dismissed”. Unfortunately, they did not offer clear definitions regarding the true meaning of these terms. I reviewed the modified Statement of Work from this past September, and this also shed no light on any possible definitions.
There is one additional slice of information that CGI shared regarding discussion periods. My source states that the CGI educator conducting the outreach session last Thursday made a point of encouraging providers in Wisconsin to enter discussion periods based on the low number requested statewide thus far. I have come to learn that based on the compressed time frames of both discussion periods and recoupment, providers are finding it to be a nearly impossible task to track dollars that were first determined to be overpaid, then either slated for recoupment or recouped, only to be subsequently reversed by a discussion period and repaid to the providers. As it is currently configured, providers are finding the discussion period to be a useless level of bureaucracy in an already laborious process. Until this paradox is meaningfully addressed, CGI should not be looking for an increase in requested discussions.
The above numbers were not the only piece of information provided by CGI in their presentation that was found to be incorrect. As part of their printed materials, CGI offered addresses for providers to enter Extended Repayment Plans with their Medicare Administrative Carriers (MACs)that were incorrect. The person conducting the outreach session did not have the correct information on hand.
One of my pet peeves about the RAC program is that the contractors are not telegraphing when outreach sessions are taking place. Based on my fire-fighting experiences of the last week, I can add an addendum to this frustration, that being that when the contractors do conduct outreach sessions, the information brought forth is self-serving and inaccurate. This whole episode serves as a lesson to the provider community to cast a skeptical eye on future outreach efforts. That is, if anyone even lets you know when they are occurring in the first place.
Paul Spencer will be a presenter at the Fi-Med RAC Summit in Milwaukee, WI on April 16th and 17th, 2012. Go to the Summit website for further information on this unique educational opportunity. Use promo code “SPENCER” to receive $50 off the registration price for a limited time.
