Rescinding of RAC audits
Description
Collection
Title:
Rescinding of RAC audits
Date:
7/23/2013
Text:
Someone asked me to post responses to my question:
“Does anyone know how a RAC can “rescind” an audit weeks after the deadline of submission of the requested documentation?
Does this “allow” them to audit the same number of claims again because they “rescinded” the audits instead of making a decision in our favor?”
this is a copy from AOPA’s email:
Significant Related Developments/ Update Report on RAC & Pre-Payment Audits
All of us will doubtless agree that there has been little, if any, good news on RAC and related audits on O&P over the past 23 months. But something quite remarkable has happened in the past couple of weeks, something that we attribute to the filing of AOPA's lawsuit. One of the major claims AOPA has made in our suit is that the CMS audit contractors have inappropriately applied the new standard articulated in the August 2011 Dear Physician Letter retroactively to claims in 2009 or 2010, well before anyone had any reason to think the standard had changed. Over the past two weeks, we have heard from a fair number of AOPA O&P provider members that the CMS RAC contractors had notified them that audits of claims with dates of service before August, 2011-the very claims that were contested by one of the AOPA suit's most vociferous assertions-have been cancelled. Just this past week, AOPA has gotten word from two separate members in different states that audit contractors explained these cancellations by saying that they had received a notification from CMS instructing that any O&P prosthetic audits relating to claims with a service date before August, 2011 be cancelled. CMS has said nothing to explain this action, but they seem to have recognized that they did make an important change in the standard via the August, 2011 Dear Physician letter AND that it is unfair and inappropriate (if not illegal) to apply that new standard retroactively.
This is not the first time CMS has initiated major changes in policy of RACs as a result of a lawsuit being filed. Earlier this year, the American Hospital Association (AHA) sued CMS relating to what AHA deemed to be inappropriate and confiscatory actions by CMS audit contractors. Shortly after the lawsuit was filed, CMS announced a new interim rule whereby if audits determined that a Medicare patient should not have been admitted as an in-patient under Part A to receive a service/surgery/procedure, Medicare (instead of its old policy which had been, by RAC audit, to claw back every dollar of the claim paid on behalf of that Medicare beneficiary) would allow the hospital to re-file a claim under Part B for the amount Medicare would have paid for that patient on a claim submitted had the service/surgery/procedure been received on an outpatient basis. So far, this has not resulted in any change in the lawsuit itself. It is possible that the government decided it would be easier to defend its position in the lawsuit if it adopted prospectively a more reasonable position.
Special thanks to Ed!
Georgia Loney
WillowBrook P&O
“Does anyone know how a RAC can “rescind” an audit weeks after the deadline of submission of the requested documentation?
Does this “allow” them to audit the same number of claims again because they “rescinded” the audits instead of making a decision in our favor?”
this is a copy from AOPA’s email:
Significant Related Developments/ Update Report on RAC & Pre-Payment Audits
All of us will doubtless agree that there has been little, if any, good news on RAC and related audits on O&P over the past 23 months. But something quite remarkable has happened in the past couple of weeks, something that we attribute to the filing of AOPA's lawsuit. One of the major claims AOPA has made in our suit is that the CMS audit contractors have inappropriately applied the new standard articulated in the August 2011 Dear Physician Letter retroactively to claims in 2009 or 2010, well before anyone had any reason to think the standard had changed. Over the past two weeks, we have heard from a fair number of AOPA O&P provider members that the CMS RAC contractors had notified them that audits of claims with dates of service before August, 2011-the very claims that were contested by one of the AOPA suit's most vociferous assertions-have been cancelled. Just this past week, AOPA has gotten word from two separate members in different states that audit contractors explained these cancellations by saying that they had received a notification from CMS instructing that any O&P prosthetic audits relating to claims with a service date before August, 2011 be cancelled. CMS has said nothing to explain this action, but they seem to have recognized that they did make an important change in the standard via the August, 2011 Dear Physician letter AND that it is unfair and inappropriate (if not illegal) to apply that new standard retroactively.
This is not the first time CMS has initiated major changes in policy of RACs as a result of a lawsuit being filed. Earlier this year, the American Hospital Association (AHA) sued CMS relating to what AHA deemed to be inappropriate and confiscatory actions by CMS audit contractors. Shortly after the lawsuit was filed, CMS announced a new interim rule whereby if audits determined that a Medicare patient should not have been admitted as an in-patient under Part A to receive a service/surgery/procedure, Medicare (instead of its old policy which had been, by RAC audit, to claw back every dollar of the claim paid on behalf of that Medicare beneficiary) would allow the hospital to re-file a claim under Part B for the amount Medicare would have paid for that patient on a claim submitted had the service/surgery/procedure been received on an outpatient basis. So far, this has not resulted in any change in the lawsuit itself. It is possible that the government decided it would be easier to defend its position in the lawsuit if it adopted prospectively a more reasonable position.
Special thanks to Ed!
Georgia Loney
WillowBrook P&O
Citation
“Rescinding of RAC audits,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235413.
