Carla Engle

In a series of communications to HHS and the Centers for Medicare and Medicaid Services (CMS) in October, U.S. Sen. Chuck Grassley, the ranking member of the Senate Finance Committee, which holds jurisdiction over Medicare and Medicaid, has been voicing a number of concerns regarding conflicts of interest on the part of CMS contractors.

As reported in the Aug. 12 AHA News Now Daily Report, CGI Technologies and Solutions Inc., the Region B RAC contractor, has issued a list of the 18 medical necessity reviews that were recently approved for audit by The Centers for Medicare & Medicaid Services (CMS).

The Centers for Medicare & Medicaid Services' New Issue Review Board has approved the first "medical necessity review" audits for Medicare's permanent Recovery Audit Contractor (RAC) program, allowing contractors to begin posting items of interest to their respective websites.

A California provider's challenge to the RAC initiative ceased to gain ground in U.S. District Court as the hospital's summary judgment motion was denied and the Department of Health and Human Services motion for summary judgment was granted last week.

The RACs will now be responsible for referring to CMS any cases of potential fraudulent activity identified during the course of their own improper payment investigations.

As the government moves forward in the review of the Medicare and Medicaid error rate data, specific trends will be noted that can better help auditors identify weaknesses in our programs or systems.

Deciding how your own internal processes are going to work once the RAC letters start rolling in is probably one of the most daunting tasks we all are grappling with at the moment.

You all may have heard the adage "delay doesn't mean denial," which is true in many life circumstances. Unfortunately, in the world of RACs, delay can mean denial: denials of claims that translate to cash lost.