Important Provider Notice: December 30, 2011
Beginning on January 3, 2012 the Recovery Auditor will no longer send Demand letters for any audits they conduct. The claims processing contractors will issue Demand Letters. DCS, the Recovery Auditor in Region A, will send informational letters for Automated Reviews in order to supply additonal information about the reviews. The Recovery Auditor will continue to send Review Results letters for Complex reviews which will be followed by a Demand letter from your claims processing contractor. If you received a Review Results letter and did not receive a corresponding Demand letter within a few weeks of receiving the Review Results letter, please contact your Claims Processing Contractor.
Providers should pay very close attention to the Demand letters they receive from the claims processing contractor as these letters provide the information about the amount of any Recovery Audit overpayment, when the Account Receivable was established and where payments should be sent.
Important Provider Notice: December 12, 2011
Discussion Periods
Discussion requests should be in writing. If during the discussion period the provider initiates the appeal process, the discussion period will then immediately be discontinued. Although a request for a discussion may be cancelled, under the RA statement of work there are no provisions for amending the request for the discussion period once it's submitted.
Important Provider Notice: October 20, 2011
DCS has recently implemented a new Discussion Period notice that specifically addresses time frames surrounding the Discussion Period. A sample is provided to you under the "Forms and Sample Documents" section for your review.The RAC discussion period begins with receipt of the review results letter for complex reviews or the demand letter for automated reviews.The discussion period continues until the issue is resolved or recoupment is complete.This period is for the provider to contact DCS via written inquiry using the discussion form, and provide additional information they feel may support their original claim or request clarification from DCS as to why the denial was issued.
For more information regarding a provider's options, please review the CMS Provider Options chart located on the CMS RAC website at;
http://www.cms.gov/Recovery-Audit-Program/Downloads/ProviderOptionsChart.pdf
Important Provider Notice: July 27, 2011
Update to Maryland RAC Audits:
DCS will be auditing Maryland claims based on claims submitted by providers to CMS, through the CMS grouper, translated as MS-DRGs.
WHY:
DCS initiated a pilot for Maryland RAC audits based on APR-DRGs. The initial audits are currently only for Medical Necessity reviews.
DCS has determined that Maryland billing departments submit claims to CMS through the CMS Grouper which assigns an MS-DRG for processing and reimbursed based on the Maryland waiver. The CMS grouper MS-DRG’s are derived from claim submissions based on the diagnosis submitted; which correspond to the APR - DRG’s.
DCS has determined that it is more beneficial and less impactful to providers to utilize the CMS grouper MS-DRG. This is the same process utilized by the MAC for this region and will allow for clearer resolution if a “like” process is utilized.
Utilizing the CMS generated MS-DRG’s will also assist facilitation for provider billing offices in identifying and responding to ADR's, Result letter's and Demand letter's when we send requests with the same MS-DRG’s originally processed by the MAC.
Conversion process for existing issues posted to the DCS website:
DCS will:
- Change the current CMS approved issues to MS-DRG’s (Associated with the corresponding APR-DRG(s) per the CMS grouper)
- Modify our existing web postings to reflect the MS-DRG’s.
- Send an updated ADR letter to the provider amending the APR-DRG(s) to correspond with MS-DRG 313. (Associated with the APR-DRG per the CMS grouper) DCS had only sent ADR issue requests at this time for medical necessity review of APR 203 Chest Pain (and APR-DRG's asscoiated with MS-DRG 313).
- Post a new letter template to our website reflecting the MS-DRG for future requests.
Important Provider Notice: February 16, 2011
DCS is overturning two automated reviews in RAC Region A that were conducted over the past several months. The two issues are: A000152009 - Untimed Codes and A000112009 NCCI – OPPS.
Letters were mailed to affected providers the first week of February 2011 with notification of the incorrect edit resulting in the overturned automated reviews.
DCS is working closely with the MACs to ensure any recouped overpayments are adjusted appropriately. The adjustment may take up to 4 weeks. Providers should receive a remittance advice that will show reason code N432 for the repayment of any related recouped amounts.
Please allow time for adjustments. Since the overpayment is being rescinded you may choose not to appeal the overpayment. Thank you for your consideration while we correct this mistake.
CMS RAC Program
The Centers for Medicare & Medicaid Services (CMS) has retained DCS to carry out the Recovery Audit Contracting (RAC) program for Region A. The RAC program is mandated by Congress aimed at identifying Medicare improper payments. As a RAC, DCS will assist CMS by working with providers in reducing Medicare improper payments through the efficient detection and recovery of overpayments, the identification and reimbursement of underpayments and the implementation of actions that will prevent future improper payments. For more information please click on the Power Point Outreach Presentation below. This is a slightly updated version of the presentation that was given at some of the Outreach sessions.
DCS RAC Region A Outreach Presentation
The RAC Program Mission
The RACs detect and correct past improper payments so that CMS and Medicare Administrative Contractors (MACs) can implement actions that will prevent future improper payments:
• Providers can avoid submitting claims that do not comply with Medicare rules
• CMS can lower its error rate
• Taxpayers and future Medicare beneficiaries are protected
CMS - DCS RAC Partnership
DCS places the highest value on its client partners; that value is the heart of everything we do and is the basis of our Mission Statement, “Being the leading provider of business services and solutions that surpass our client expectations and deliver exceptional value.”
DCS is working in Region A which consists of the following states: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont.