Over the first six weeks of 2012, RAC coordinators nationwide have learned the hard way about the lack of effectiveness of an advanced warning.
Late last year, it was announced that the responsibility of issuing demand letters was being transferred from the RAC contractors to the Medicare Administrative Contractors (MACs). As the process revealed itself in January, what seemed like a simple transfer of duties has turned into mayhem. Information as simple as a common mailing address for RAC requests has been lost in the transfer, leading to short-term disintegration of the established RAC process.
In the past few weeks, two signal flares of changes on the horizon related to RAC activities have been announced by CMS that have the potential to cause a similar disruption.
On January 26, CMS released Change Request 7673. According to this document, effective July 1, 2012, the Multi-Carrier System (MCS) will include edits for common improper payment issues identified by the RAC contractors. These issues include pulmonary diagnostic procedures on the same date as an E/M encounter, IV hydration procedure reporting as it relates to total time, new vs. established patient services, and incorrect reporting using the -62 modifier.
These edits are mostly the result of findings from automated reviews, which I have stated before could be determined by training a pigeon to hit a button. It should also be pointed out that every one of these issues could be solved on the provider end with education of the billing staff. Remembering to place a -25 modifier on E/M services on the same day as unplanned pulmonary diagnostic procedures could be the solution to the first issue indicated above. If there is a certified coder on your staff, this person should know this and has no reason to be unaware of how to correctly use a modifier in this situation.
The second warning sign was one we all briefly became aware of at the end of 2011. To hearken back to a few weeks ago, CMS announced that the planned demonstration project that would have enabled Medicare RAC contractors to conduct pre-payment audits was being delayed from its original implementation date of January 1, 2012. CMS has now subsequently announced that these type of audits should begin “on or around June 1, 2012″.
Upon the initial announcement of prepayment audits, there was consternation throughout the industry that a complex review process that by some sources is unsuccessful in their task 67% of the time was now going to expand into prepayment audits due to the “success” of post-payment review. I for one am not setting aside my animus towards the RAC program simply because prepayment audits have been delayed by 5 months. The Medicare RAC program has demonstrated itself to be the solution to Medicare overpayments in the same way that random placement of land mines on highways is the panacea to rush hour traffic congestion. The simple task of changing which entity sends out demand letters has led to 6 weeks of chaos. How can I possibly believe that adding difficult tasks to the work that is clearly overwhelming those who are doing it will lead us all to a good place?
Add to this the fact that RAC contractors now appear to be chasing underpayments based on the promise of higher contingency fees, and 2012, the alleged year of the Mayan Apocalypse, appears to have its first plague ready to go in the starting gate. It is worth noting that getting advanced notice of turmoil is never a guarantee of a solution to the problem.
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