CMS has announced a temporary suspension of new Recovery Audit Contractor (RAC) audits, effective February 21, 2014. The RACs currently under contract with CMS are directed to discontinue sending Additional Documentation Request (ADR) to providers until further notice.
Under mounting pressure from healthcare providers claiming they have been subjected to overzealous RAC contractors, coupled with a massive backlog of cases pending appeal, CMS has ordered recovery auditors to cease in their requests for medical records. Approximately one-third of appeals result in a favorable decision for the providers.
The contracts with the RACs are expiring and CMS is beginning a new contract review cycle. CMS is winding down operations with the existing RACs so they can complete all outstanding claims review by the end of the current contracts. The existing RACs are welcome to respond to the new solicitation but there is no guarantee their contracts will be renewed.
We will communicate more detailed explanation of these and other RAC actions CMS is contemplating as soon as the information comes available.
Kirk Reinitz, CPA