New year brings new national RAC for DMEPOS

In 2014, CMS announced that Connelly LLC, currently a contracted auditor in Medicare Region C, was awarded the contract to become the first national recovery auditor for DMEPOS. The new national RAC will review claims throughout the entire country for durable medical equipment orthotics, prosthetic and supplies, hospice, and home health effective January 1, 2015.

The Centers for Medicare & Medicaid Services reported on December 30th, “CMS has awarded the Region 5 Recovery Audit contract to Connolly, LLC. The purpose of this contract will be to support the Centers for Medicare & Medicaid Services (CMS) in completing this mission through the identification and correction of improper payments for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), and home health/hospice (HH/H) claims submitted under Title XVIII of the Social Security Act (the Act).”

 “The Recovery Auditor will review all applicable claims types through the appropriate review methods and work with CMS and the DME and HH/H MACs to adjust claims to recoup overpayments and pay underpayments. This award marks the beginning of the new Recovery Audit contracts and is the start date of the implementation of many improvements to reduce provider burden and increase transparency in the program.”

This announcement obviously leads to more questions than answers: Will RAC activity increase/decrease with this change? Is the new RAC prepared for the increased volume? What happens to audited claims from 2014? Will the auditors remain focused on technical issues or move toward the intent of the program by targeting medical necessity? 

OPGA will keep you updated of any further news about rollout of the national RAC and other issues impacting independent O&P providers.

 

 

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