Oregon Medical Association - Recovery Audit Contractor Program

11740 SW 68th Parkway, Suite 100
Portland, OR 97223
Phone: (503) 619-8000
Fax: (503) 619-0609
Contact: Stephanie Munoz
Email: oma@theOMA.org
Hours: 8 am - 5 pm

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News and Resources

From OMA-PRN on June 18, 2009:

Register Now for RAC Educational Session on July 23 -CMS and HealthDataInsights, Inc. (RAC for Oregon) to Host Educational Session

Click here to register online

The Recovery Audit Contractors program is administered by the Centers for Medicare and Medicaid Services to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care providers submit claims that do not meet Medicare’s coding or medical necessity policies. Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed.

Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B.

The OMA will be hosting an educational session with CMS and HealthDataInsights (the RAC for Oregon) on the RAC program for physicians and their staff on July 23 at the OMA Headquarters. There will be two identical programs to choose from, a morning session (9:30-noon) and an afternoon session (2:00-5:00 pm). The cost is $25 per person.

Shortly after CMS conducts this educational session for physicians and their staff, HealthDataInsights, Inc. will start auditing claims. You do not want to miss this opportunity to learn more about the RAC program and how you can prepare for when the RACs come to your office.

For more information on the RAC program, visit www.cms.hhs.gov/rac or contact Reina at Reina@theOMA.org or (503) 619-8000. For more information on registering for this event, contact Jenn Webster at Jenn@theOMA.org or (503) 619-8000.

From 2009 April STAT:

Recovery Audit Contractors Program Protest Resolved – Oregon set to be Reviewed in August

Late last year, the Centers for Medicare & Medicaid Services delayed implementation of the Recovery Audit Contractors program due to protests that were filed. On Feb. 4, the protests were settled and CMS will now continue RAC program implementation. The new RAC for Region D, which includes Oregon, is HealthDataInsights, Inc. of Las Vegas, Nevada. The program is scheduled to come to Oregon in August of this year.

As reported in past issues of STAT, the goal of this RAC program is to review physician and other health care provider claims to identify underpayments and overpayments and to recoup overpayments for the Medicare Fee-For-Service Program. The RACs will be paid on a contingency fee basis on both the overpayments and underpayments they find.

CMS suggests that physicians prepare for the start of the program by conducting an internal assessment to ensure that submitted claims meet the Medicare rules. Other steps to consider include:

Identifying where improper payments have been persistent by reviewing the RAC website and identifying any patterns of denied claims within their own practice or facility.
Implementing procedures to promptly respond to RAC requests for medical records.
If the physician or health care provider disagrees with the RAC determination, filing an appeal before the 120-day deadline.
Keeping track of denied claims and correcting these previous errors.
Determining what corrective actions need to be taken to ensure compliance with Medicare’s requirements and to avoid submitting incorrect claims in the future.

The OMA will work closely with the AMA and CMS to identify how to best prepare physicians and their staff for this process. The OMA, along with other medical associations, also sent a letter to CMS stating their concerns regarding the RAC program. To read the full RAC program update, visit the CMS website at www.cms.hhs.gov/RAC/.

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