RAC Program Update: CMS Appoints Provider Relations Coordinator


On June 2, 2014, CMS posted a brief update on its Recovery Audit Contractor (RAC) program website announcing the creation of a “Provider Relations Coordinator” position within CMS.  The announcement states that the role of the Provider Relations Coordinator will be to “help increase program transparency and offer more efficient resolutions to providers affected by the medical review process,” but offers no other details as to the duties or job function of the Provider Relations Coordinator. 

The announcement encourages providers to seek to resolve issues regarding specific claims with the applicable RAC or Medicare Administrative Contractor (MAC), reserving “larger process issues” for the Provider Relations Coordinator.  For example, CMS stated it would encourage a provider to contact the Provider Relations Coordinator in a situation where the provider believes the RAC is failing to comply with the document request limits or has a pattern of not issuing review results letters in a timely manner.  CMS’s announcement also states that providers can send suggestions as to how to improve the RAC/MAC medical review process to the Provider Relations Coordinator. 

Latesha Walker will serve as the Program Relations Coordinator and may be contacted by email at RAC@cms.hhs.gov (for RAC issues) and at MedicareMedicalReview@cms.hhs.gov (for MAC issues). 

The establishment of a Provider Relations Coordinator is the latest in a series of RAC program changes that CMS has announced in recent months, all of which, according to CMS, are designed to limit the burdens providers experience with RAC complex medical review audits.  In February, CMS announced five changes that it anticipated incorporating in the next round of RAC contracts.  These changes include adjusting additional document request limits in accordance with a provider’s denial rates and withholding RAC contingency fees until after the second level of appeal, to the Qualified Independent Contractor. 

Reporter, Isabella Edmundson, Atlanta, +1 404 572 3527, iedmundson@kslaw.com.


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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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