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DecisionHealth stock imageYou can add new, state-level recovery audit contractors (RACs) to your list of worries starting in 2012. All states are required to implement Medicaid RACs by Jan. 1 or lose out on federal funding, according to a CMS final rule posted Sept. 14. The new state-level RACs will be paid by states, operating under the same “contingency fee” model that the federal RACs use – i.e. they are paid based on cash recovered from you and your peers.

Image from www.cms.govThe next time you get a request for records from your carrier or recovery audit contractor (RAC), you would be able to send it electronically under a new CMS pilot program. The Electronic Submission of Medical Documentation (esMD) lets you send any requested record as a PDF document, which typically means you scan or convert the required documents into PDFs. This could reduce the time it takes to meet a records request, although you will probably need to go through your claims clearinghouse to submit information via esMD.

DecisionHealth stock imageYou can look forward to overpayment demand letters -- based on audits by your recovery audit contractor (RAC) -- coming from your Medicare Administrative Contractor (MAC) or carrier, starting Jan. 1, 2012. Your MAC or carrier will now issue the demand letters, but everything else about the recoupment process will stay the same, including the 40-day discussion period and the appeals process.


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