There are things in this world that I flat-out like to avoid, but always find anyway. The current edition of the Autumnal cough that I am dealing with would be one such example. Presidential “debates” would be another (as I was doing something last night that brings about more intellectual stimulation: I was talking to my cat).
Possibly the best example of personal avoidance is elected officials. Living in a kleptocracy such as ours, I keep my distance lest the Larceny Fever rub off. Sadly, because their creations (bills and laws) affect my industry directly, I must watch their efforts carefully while taking heed never to be in the same room. As it happens, one such bill affects the RAC process, and as a result my ramblings in this space.
Missouri’s 6th District Representative Sam Graves (a man who has made more news on a personal than professional front in 2012) and California’s 29th District Representative Adam Schiff (not the fictitious old guy from “Law & Order”) introduced the Medicare Audit Improvement Act of 2012. The aim of the bill is to punish RACs financially for failing to comply with program requirements. The financial penalties would be paid back to the Medicare program. In addition, the bill would allow for inpatient claims to be rebilled as outpatient in certain circumstances, as well as requiring physician review of all denials. In perhaps the least-surprising maneuver in the history of humankind, the AHA has already signed on as a supporter.
As the bill is a first draft, it should be interesting to see what changes are made to the proposed legislation. One item conspicuously missing is repercussions for other contractors for ignoring time frames for review as stated in the Medicare appeals process. With ALJ hearings now being scheduled almost a year in advance, it would appear that the appeals process has collapsed.
While we’re on the subject of RAC activity, the information grapevines have been lighting up like Bob Marley with information about Medicaid RAC audits occurring nationwide. In Ohio, CGI, the Medicaid RAC contractor, is going back five years, rather than the three years mandated in the 2011 Final Rule. In Connecticut, New York and Idaho, HMS has been going after improper Medicaid secondary payments on Medicare primary claims (the determinations of which, in several cases, have been in error; big surprise). In North Carolina, HMS has gone after ambulance payments. HDI in Kansas has been going after payments by Medicaid that should have been paid by a Medicaid HMO, as well as a variety of DRGs.
In other Medicaid RAC news, the State Medicaid RAC interactive map that was available on the CMS website is no longer accessible. The information on the map was terribly outdated and not at all useful, so perhaps it is finally being updated. I’ll keep the readers posted as the weeks pass.
What this all adds up to is that after many delays and much hand-wringing, the Medicaid RAC program is up and running across the country. Based on the problems seen with the first reviews trickling in, provider response should be aggressive and vigilant. You can direct reports of problems to Angela Brice-Smith, who based on my records is the CMS director of the Medicaid Integrity Group. We all trusted that the Medicare RAC program would be semi-functional, only to find out too late that this was far from the case. If the Medicaid RACs are screwing up, make your voices heard.
Remember that the Great Kleptocracy continues unabated unless the Uninfected rise up in dissent. This is one uprising that providers cannot afford to avoid.