After a five-month hiatus, CMS announced this month that it will immediately begin modifying contracts with current RACs in order to restart reviews as delays continue to plague the awarding of new Recovery Auditor contracts.  The restart will be limited, but will include reviews of claims for spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures.  CMS stated that reviews will largely be automated, but “a limited number will be complex reviews of topics selected by CMS.” 

CMS announced in February that it would pause review operations  in order to allow current RACs to clear workflows by the end of the contract period, anticipating the completion of a procurement process for new contractors.  However, CMS acknowledged that “continued delay” in that process led to its decision to continue limited review operations with its current RACs.  Though it gave no specific timeline for an end to the limited reviews and selection of new contractors, CMS stated that it “remains hopeful that the new round of Recovery Auditor contracts will be awarded this year.”

More Information:

Recent RAC Updates from CMS