Diversified Collection Services, the Medicare recovery audit contractor for Region A, will begin audits on durable medical equipment billed to Medicare, bringing the RAC program live nationwide.
Region A consists of Connecticut, Delaware, the District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.
DCS, based in Livermore, Calif., is the last of the four contractors to launch RAC audits. PRG-Schultz USA, Inc., will act as a subcontractor. Audits began in August in the other three regions.
CGI Technologies and Solutions, Inc., of Fairfax, Va., launched audits in Region B, consisting of Indiana, Michigan and Minnesota. Illinois, Kentucky, Ohio and Wisconsin.
Connolly Consulting launched RAC audits in region C, targeting physicians and hospitals in South Carolina, Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico and the U.S. Virgin Islands.
HealthDataInsights, Inc., of Las Vegas, the Medicare recovery audit contractor for region D, began audits in Alaska, Arizona, California, South Dakota, North Dakota, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, Oregon, Utah, Washington and Wyoming.
Connolly Consulting and HealthDataInsights have announced they will review claims for blood transfusions, untimed codes, IV hydration therapy, bronchoscopy services, once-in-a-lifetime procedures, pediatric codes exceeding age parameters and injections of pegfilgrastim for 6 mg, paid since Oct. 1, 2007.
CGI Technologies will review claims for blood transfusions, IV hydration therapy and bronchoscopy services.
The government reportedly recovered nearly $700 million in improper Medicare payments through its RAC pilot program, conducted from 2005-08.
"The RAC demonstration program has proven to be successful in returning dollars to the Medicare Trust Funds and identifying monies that need to be returned to providers," CMS officials have said. "It has provided CMS with a new mechanism for detecting improper payments made in the past and has also given CMS a valuable new tool for preventing future payments."
Coding experts have warned that providers will need to take special care to document their services correctly, because without adequate proof of the service, CMS will ask for its reimbursement money back. RAC audits so far have not included complex reviews of medical records, but now is the time to prepare for that, experts have said.