p-spencerEDITOR’S NOTE: Last week on Monitor Monday, our weekly poll asked listeners  if they were satisfied with their RAC’s outreach efforts. Only 10 percent said they were “satisfied and well informed.” Thirty-four percent responded that they were “not satisfied” and “not well informed.” An astonishing 56 percent asked, “What Outreach?”

When attempting to blow up ignorance, there is nothing quite as satisfying as being the guy who lights the fuse.

Since my first article on the subject of poor RAC provider outreach appeared here on Nov. 2, the feedback I have received on my conclusions has verified my suspicions. I’ll detail those below, but first I’d like to fill in the blanks that remained as my last article went to press.

In the Beginning

As a reminder, I sent e-mails to DCS, the Region A RAC, and Connolly, the Region C RAC, requesting schedules for upcoming provider outreach education sessions. I received a response from DCS asking for my provider NPI number so my request could be sent to the “correct area.”

When I responded that I worked for a provider financial management company representing clients in New York and Connecticut, I received a response from the same person (she must have been the “correct area” all along) stating that DCS would be presenting a joint outreach webinar with NGS in February for providers in those states. I also was told that I should check the NGS website “later in 2011 or early 2012 for updates.”

Tracking Down the MAC

That covered only two of the 11 states under the DCS umbrella, so I decided to go deeper. I went to the website of NHIC, the Jurisdiction 14 MAC covering the balance of the New England states. Its education schedule ran only to the end of 2011 and included no upcoming sessions on RAC activities. A review of the website for Highmark Medicare Services, which represents the rest of the states in the DCS universe, yielded identical results.

To date I have not received a response to my inquiry to Connolly, but I followed the lead I received from DCS and reviewed the websites of MACs within Region C. I began with Palmetto GBA for West Virginia, Virginia and the Carolinas, and found no upcoming education events. Next I reviewed Cahaba for Tennessee, Alabama, Georgia and (currently) Mississippi, with similar results: no events scheduled for the remainder of 2011. Similarly, Pinnacle for Arkansas and Louisiana and First Coast Service Options for Florida had nothing related to RAC scheduled for the remainder of 2011. Trailblazers, representing the states in the western portion of Region C, showed nothing through January 2012.

Don’t Have to Educate

Yet the Connolly saga didn’t end there. On the heels of my article being published I received a rather enlightening e-mail from a reader in a Trailblazers state. This person has a problematic issue  identified by Connolly during a RAC audit of which she cannot get a resolution. In a futile attempt at identifying a solution, she contacted Connolly and was told by a phone representative that they don’t have to educate. I invite this week’s reading audience to reread that last sentence and internalize it.

Now let’s go back to the Fiscal Year 2010 Report to Congress on RAC implementation, which was released in late September. On Page 9 of the report is a summary of the outreach efforts that CMS has undertaken, but this segment mentions nothing about what the individual RACs have done to satisfy the education requirements detailed in the RAC Statement of Work. It’s also worth nothing that the wording in the Report to Congress gives the distinct impression that CMS has completed its outreach efforts, save for occasional updates to their FAQs as they pertain to the RAC program. In this context, a Connolly phone representative stating that they don’t have to educate the provider community should set off alarm bells.

No Outreach in Sight

To review, CMS has completed its outreach efforts, the RACs either have nothing scheduled or have yet to update the education calendars on their websites, and the MACs will get to it all next year (after all, what’s the rush?) Meanwhile, all the provider community is requesting is feedback and guidance – and instead we’re being left needlessly in the dark.

About the Author

Paul Spencer is the compliance officer for Fi-Med Management Inc., a national physician practice financial management company based in Wauwatosa, Wis. Paul has more than 20 years of experience across all facets of healthcare billing, including six years spent with insurance carriers. In his current role with Fi-Med he acts as a physician educator on issues related to E/M level of service and documentation audits by CMS and other outside entities. Paul has carried the CPC and CPC-H credentials from the American Academy of Professional Coders since 1998.

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Authority and Responsibility for the Utilization Management (UM) Plan

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