There is something about Florida in February, our sunny State just wrapped up Super Bowl XXXXIV as the Saints Came Marching In, Jamie McMurray took the checkered flag at the Valentine’s Day Daytona 500, the official Strawberry Festival is imminent, thousands of Harley riders are rolling into Daytona Beach for Bike Week 2010
and the World Series Champion New York Yankees will begin Spring Training in Tampa shortly as the early wave of spring breakers hit the beaches on both Florida coasts.
Love is in the air, and our RacMonitor.com readers are invited to send our team “love letters in the sand”. Well, OK, they don’t have to be in the sand – but we would like to hear from you via email.
Why you say? Well now that the RAC process is fully underway, we fully into the new RAC program. There are new rules, new processes and new players.
Looking Back, Moving Forward
Over the past several years we have all learned lessons from the RAC Demonstration project. Colleagues in Florida, New York and California have shared their tales of woe, their struggles, their frustrations and their successes. It has helped to understand the macro concept of the intent of the RAC program: request records, review records, deny records, collect a fee -this is the real world of the RAC contractor.
Now that the multiple RAC processes of automated review, DRG validation, and discharge validation are underway (with medical necessity reviews looming), those providers in Region C are reporting their current interactions with Connolly, the Region C RAC, the first to post issues and begin the process.
Region C providers are reporting claims denied on automated review justifiable (they goofed, and they agree that the money should be recouped). Also proved justifiable are recouped funds that were appealed, as the denials did not comply with the CMS approved issues. In fact, providers in Region C are already on their second round of appeals resulting from the automated reviews begun last quarter.
Too Much Information
Internet blogs, industry listservs, and emails among colleagues are multiplying. Everyone is eager to receive the news of what issues are being posted, how the process is working, what is happening during the discussion period, and looking to get a leg up to share with their facility’s RAC team.
OK, so you post a question to one of the listservs, and you get a thousand answers. Which one is right? Are any of them right? Which one is MORE right? OK, so you get my drift? There is a lot of great information being shared formally and informally throughout the industry. What is important is to put the information in context, understand how it might apply to your facility, and what are the reference citations?
Case in Point
For example, how the Region C RAC conducts medical record reviews may vary from how the Region B RAC conducts a similar review. Let’s say you post a question on a healthcare blog asking about the medical records request limits. A reference is listed. How do you know if the reference is current? This issue of medical records request limits has changed several times in recent months. Do you have the current citation?
Fog in the Blog
As you are reviewing some of the postings on the blogs and listservs, pay attention to those that start with:
- I heard that…….
- In the demonstration project….
- They are not reviewing small dollar claims…
- Physicians will probably not be reviewed…
- The RAC Medical Director will be reviewing all claims…
- The rebuttal period is the same as the discussion period…
- The Medicaid Integrity Contractors are following the RAC Guidelines
- If you are following the MAC’s LCD, you should have no problems…
- Eventually you will get all your money back…
In some instances the information may be inaccurate; in others it could be accurate, but out of date, and in some cases it is just opinion based on experience, but with another RAC (not yours).
Gathering and weighting all the available information is good, but to put it in perspective, it may not be relied upon if it is not current and not applicable to your RAC contractor. All the editors and writers at RACMonitor.com are looking for your emails with questions, comments and experience. This will help frame critical important articles and updates and allow us to tap experts in the field for accurate citations of rules, regulations and guidelines.
It is now time to talk about the current process, as we continue to apply the lessons from the demonstration program, we are now in the midst of the permanent program with the opportunity to rapidly bring information back to you: our readers!
Send us some love.
About the Author
Nancy Beckley is a co-founder and president of Bloomingdale Consulting Group, Inc., providing consulting services to the rehab professional. Nancy is certified in healthcare compliance by the Healthcare Compliance Board, and serves on the Part A and Part B Provider Outreach Education and Advisory Panel for First Coast Services Options (Florida Medicare). She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities.
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