You won't believe this one! Fwd: RAC AUDIT Information Correction

You won't believe this one! Fwd: RAC AUDIT Information Correction

Lou Haberman CPO

7/27/2013

Can someone confirm this?
 
 
  
____________________________________
 Sent: 7/27/2013 6:05:23 P.M. Eastern Daylight Time
Subj: Fwd: RAC AUDIT Information Correction





  
____________________________________
 From: <Email Address Redacted>
To: <Email Address Redacted>
Sent: 7/27/2013 2:41:53 P.M. Eastern Daylight Time
Subj: RAC AUDIT Information Correction


 
( <URL Redacted>)
 

RAC AUDIT Information Correction



We want to immediately share with you the email the Academy received from
CMS regarding recent audit rescissions (included below). Upon inquiry, CMS
informed us that the rescission letters to providers in Region A were sent
in error. CMS has apologized for any confusion this has caused.

The Academy views this as an unfortunate turn of events and conveyed our
displeasure with this decision to CMS. The Academy continues to be deeply
concerned about these unjustifiable audit practices. We will continue to
work with the O&P Alliance to convince CMS that such legacy audits need to be
stopped in the interests of our patients and businesses. Unfortunately,
this means that clinicians must continue to respond to CMS audit requests. We
also urge you to appeal any audit result that you feel is erroneous.

Should you have any thoughts on this issue or suggestions as to how we
might best move forward, don't hesitate to contact <Email Address Redacted>
(mailto:<Email Address Redacted>) . We always appreciate hearing from you.

The email received from CMS begins below:



Good Afternoon Mr. Rosenstein,

This is in response to your e-mail of July 22, 2013 to Marilyn Tavenner
concerning Recovery Auditor review of prosthetic claims. You asked if the
Centers for Medicare & Medicaid Services (CMS) has decided to change the look
back period for Recovery Auditor review of prosthetic claims. The answer
is no.

Under CMS regulations 42 CFR 405.980 Medicare review contractors may
reopen a claim for any reason within one year and after one year but up to four
years if there is good cause. CMS, however, limited Recovery Auditors in
their statement of work to a three year look back period. Prosthetic claims
reviewed by Recovery Auditors are subject to the three year look back
period for Recovery Auditor review. You mention that members of your
organization have received letters from Performant, the Region A Recovery Auditor
rescinding record requests. These rescission letters were issued incorrectly.
However, the Recovery Auditor will not reissue record requests for claims
for which it sent letters rescinding the original record request.

CMS did issue direction to the Recovery Auditors to limit review of Power
Mobility Device (PMD) claims to the last twelve months. As you may know,
CMS is undertaking a demonstration to prior authorize PMDs in seven States.
In these seven States, one hundred percent of PMDs subject to the
requirement of the demonstration are being reviewed. This demonstration started in
August 2012. The twelve month look back period makes the Recovery Auditor
review of PMD claims in the non-demo States parallel the timeframes of
claims reviewed under the demonstration. Our intention was to issue an
instruction only with regard to PMDs, and CMS will issue clarification on our
website.

Please accept our apologies for any confusion that was caused by the
rescinded record requests.

CDR Brian Elza, PT, DPT, OCS
Physical Therapist, United States Public Health Service

Deputy Director, Division of Recovery Audit Operations
Provider Compliance Group/OFM
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244



 
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