RAC Program on the Move

BALTIMORE — CMS said Friday it’s set to get going again
with implementation of the national recovery audit contractor
program.

The agency awarded contracts to four recovery audit contractors,
or RACs, in October, but contract protests put implementation on
hold. Those protests were resolved Feb. 6, CMS said, so ramp-up of
the program will now continue.

In a three-year demonstration in six states — California,
Florida, New York, Massachusetts, South Carolina and Arizona
— CMS gave the RACs $317 billion in paid claims data on which
more than $900 million in overpayments was collected and $37
million found in underpayments. Those results propelled the agency
to implement permanent RACs in areas that match the four DME MAC
jurisdictions, and the post-payment review program will roll out to
all 50 states by Jan. 1, 2010 (see RACs
Ready to Rack Up Improper Payments, HomeCare Monday,
Nov. 17, 2008).

The national RACs remain those announced in October:

• Diversified
  Collection Services (DCS) of Livermore, Calif., in Region A,
  initially working in Maine, New Hampshire, Vermont, Massachusetts,
  Rhode Island and New York;
• CGI Technologies
  and Solutions of Fairfax, Va., in Region B, initially working
  in Michigan, Indiana and Minnesota;
• Connolly Consulting
  Associates of Wilton, Conn., in Region C, initially working in
  South Carolina, Florida, Colorado and New Mexico; and
• HealthDataInsights (HDI)
  of Las Vegas, Nev., in Region D, initially working in Montana,
  Wyoming, North Dakota, South Dakota, Utah and Arizona.

As part of the settlement of the protests, the four RACs will
contract with subcontractors to supplement their efforts.
PRG-Schultz will
serve as a subcontractor to HDI, DCS and CGI in Regions A, B and D.
Viant Payment
Systems will serve as a subcontractor to Connolly Consulting in
Region C. CMS said each subcontractor has negotiated different
responsibilities in each region, including some claims review.

With regard to next steps, over the next several months, CMS
said it will begin contacting associations and providers to discuss
provider outreach sessions involving the RACs.