CMS Spokesman Declares Patient Status Reviews Are Still Off Limits for RACs

RACs may not be allowed to conduct patient status reviews... but for how long?

RACs may not be allowed to conduct patient status reviews… but for how long?

Recovery Auditor Contractors will not conduct inpatient hospital patient status reviews under the recently announced RAC contract extensions, according to a CMS media spokesperson, quoted in the January 12 2015 Report on Medicare Compliance (registration required).

Here’s the quote, from Editor Nina Youngstrom’s article that headlined the most recent report from AIS Health:

“The Recovery Auditors will not conduct any inpatient hospital patient status reviews during this limited restart period,” spokesman Tony Salters says. The incumbent RACs mostly will do automated reviews, although some will be complex, requiring hospitals to turn over medical records to the RACs.

Perhaps this is a relief to providers, to hear that the Medicare RACs will be at least somewhat limited in the types of reviews they can do under this new extension, but it remains to be seen exactly what those limitations will be in actual practice. There were some limits established last fall, or at least a memo was sent to congressional staffers to reassure the US Congress that CMS was at least attempting to control the RACs before the new contracts could be awarded.

However, with the exception of the legislation that restricts RAC reviews of inpatient hospital patient status through March 31, 2015, there is nothing to stop CMS from opening these flood gates or simply adding issues for review by RACs, at will.

Can We Count On This Limitation?

"Can I get that in WRITING?"

“Can I get that in WRITING?”

Therefore, since nothing is really in writing from CMS, we remain without any regulatory “cover.” That is, there is nothing in writing that consistently outlines exactly what is going on, what will happen if CMS changes its mind, and what will be done to inform, educate and cooperate at all with the provider community. The statements made by a media spokesperson are dubious, in the first place, and are not useful, as such, since they do not provide anything that one might be able to quote in front of an Administrative Law Judge, for example. The limitation we are being assured of, if we are of a mind to believe it, is merely a statement of potential intent, and does not even rise the level of being a “promulgated rule.” Even it if were reliable as such, all of these promulgated rules are subject to change at any moment. And what is to prevent such rules from being applied retroactively?

A friend of mine who is a lawyer once told me that on the first day of law school, they teach you to “never put anything in writing.”

Evidently, the rule makers at CMS have been to at least one day of law school.

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One Response to CMS Spokesman Declares Patient Status Reviews Are Still Off Limits for RACs

  1. Pingback: “Finally Friday!” Audit Risk Score: What Do YOU Measure? | Appeal Academy

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