CMS has announced that it will postpone its Recovery Audit (RAC) Prepayment Review demonstration project that would have held Medicare payment to hospitals for claims for 15 procedures until the Medicare RAC reviews the claim to ensure compliance with Medicare payment rules.
The Medicare RAC Prepayment Review demonstration called for the RACs to conduct prepayment review of claims for 15 procedures that historically result in high rates of improper payments. Many doctors were unhappy with the proposed program, especially cardiologists who would be most affected since 11 of the 15 procedures identified for Medicare RAC prepayment review affect cardiologists.
The prepayment review program, which would have affected Florida and 10 other states, generated many “comments and suggestions” since it was announced in November 2011, according to a statement from CMS. Such heavy criticism prompted the agency to indefinitely delay the three-year project, which was scheduled to begin Jan. 1, 2012, while it considers the comments and suggestions submitted by stakeholders. CMS said it would provide at least 30 days notice before re-launching the delayed project.
RACs were designed for post-payment reviews; however, recent program initiatives from CMS indicate that the agency plans to allow Medicare RACs to also do prepayment reviews. According to CMS officials, the recent RAC expansions will change the existing “pay-and-chase” model, ultimately lowering Medicare’s error rate by preventing improper payments.
For more information about Medicare RACs, prepayment reviews, or other Medicare payment issues, please contact Rafael A. Gaitan, Esq.