Becker's Hospital Review

23 Financial Management C MS has made a number of changes to the Recovery Audit Contrac- tor program after evaluating provider concerns raised about the program. Here are 10 things to know about the changes to the RAC program. 1. CMS will limit the RAC look-back period for patient status reviews to six months after the date of service if the hospital has submitted its claim within three months of the date of service. 2. CMS will establish additional documentation request limits based on a provider's compliance with Medicare rules. Providers with low denial rates will have lower additional documentation request limits while providers with higher denial rates will have higher limits. This change was made based on industry feedback that the additional documentation limits are the same for all providers of similar size and are not adjusted based on a provider's com- pliance with Medicare rules. 3. The additional documentation request limits will include instructions "to incrementally apply the limits to new providers under review." This change was made based on industry concern that providers who are not familiar with the RAC program are immediately receiving requests for the maximum number of medical records allowed. 4. Providers have shown concern about each recovery auditor's provider por- tal being formatted differently and showing different information. Based on that feedback, CMS will work with auditors to enhance their provider por- tals, "including more uniformity and consistency in the claim status section." 5. Recovery auditors will not receive their contingency fee until after the sec- ond level of appeal is exhausted. Previously, the auditors received their con- tingency fee immediately upon denial and recoupment of the claim. CMS said the delay in payment "helps assure providers that the decision made by the recovery auditor was correct based on Medicare statutes, coverage deter- minations, regulations and manuals." 6. Recovery auditors will be required to broaden their review topics to in- clude all claim/provider types. This change was made based on providers' concern that recovery auditors focus much of their resources on inpatient hospital claims. 7. Recovery auditors will be required to maintain a first level of appeal over- turn rate of less than 10 percent. That rate excludes claims denied due to "no or insufficient documentation or claims that were corrected during the appeal process." 8. Based on industry feedback that providers do not have a valid method to rate recovery auditors' performance, CMS will consider developing a pro- vider satisfaction survey. 9. CMS said it "is confident that these changes will result in a more effective and efficient program, by enhanced oversight, reduced provider burden, and more program transparency." 10. The RAC program changes are effective with each new contract award, beginning with the contract awarded Dec. 30, 2014. n W ith the number of hospital deals al- ready announced in January, this year could be a busy one for hospital trans- actions, according to a recent report from Irving Levin Associates. In January 2014, there were eight hospital deals announced. With six deals announced halfway through January, the sector is "on track to match last January's total," according to the report. Some of the significant deals announced so far this month include Johnstown, Pa.-based Co- nemaugh Health System acquiring Roaring Spring, Pa.-based Nason Hospital for $12 million, Stony Brook (N.Y.) University Hospital closing a long-planned deal to add Southampton (N.Y.) Hospital and Crittenton Hospital Medical Cen- ter in Rochester Hills, Mich., joining Ascension Health Michigan, part of St. Louis-based Ascen- sion Health. n CMS Makes Changes to RAC Program By Ayla Ellison 2015 May Be Busy Year for Hospital Deals By Ayla Ellison SAVE THE DATE! Becker's Hospital Review 6th Annual Meeting May 7-9, 2015 Swissôtel - Chicago, Illinois 153 Great Health System Executives Speaking • 119 Sessions • 212 Speakers To learn more visit www.BeckersHospitalReview.com To register, visit www.regonline.com/hospitalreview6thannualmeeting

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