Wednesday, November 12, 2014

CMS Announces Plan to Issue New Recovery Audit Contracts For Regions 3 and 5

Dan Ciolek

On November 4, the Centers for Medicare and Medicaid Services (CMS) announced an update on their Recovery Audit Program website announcing plans to issue awards to two Recovery Audit Contractors (RACs) by the end of the year. On the website, CMS discusses that the new contracts for Recovery Auditor Regions 1, 2, and 4 remain under a pre-award protest, which is expected to continue into late summer of 2015. However, the procurement process continues for Region 3 (Part A / Part B claim reviews), which includes Florida, Tennessee, Alabama, Georgia, West Virginia, Virginia, North Carolina and South Carolina; and, for Region 5, which will be the national contract for DMEPOS and Home Health & Hospice claim reviews. CMS discusses on the website that they remain hopeful that these two new contracts will be awarded before the end of this year. However, in direct conversations with AHCA, CMS anticipates that it is quite likely that the new contract awards may receive post-award protests which may further delay the implementation of these new RAC contracts.

Previously, CMS had announced that the current RAC contractors were instructed in late August 2014 to resume conducting limited reviews (which had been on a pause since late February), pending the completion of the new RAC procurement process. To date, therapy manual medical review (MMR) was not part of this limited review resumption, however, AHCA has learned this week that CMS intends to resume limited therapy MMR in the near future. More details will be provided soon.

For more information, contact Dan Ciolek at

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