The Centers for Medicare and Medicaid Services has posted the statements of work for its new Medicare Recovery Audit Contractors (RAC), a map depicting the new RAC regions and contact information for each RAC.
CMS in October awarded five new Medicare RAC contracts. Three contractors will perform post-payment review of Part A and B Medicare fee-for-service claims for all provider types other than home health/hospice and Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).
New Jersey is in Region 4 under the new contract, which means that HMS Federal Solutions is the RAC for the state. Its email address is racinfo@emailhdi.com. Medicare Part A inquiries can be made to 1-866-590-5598, while Medicare Part B inquiries should be directed to 1-866-376-2319.
Performant Recovery Inc. will perform post-payment review of home health/hospice and DMEPOS claims nationally.
Its contact information is info@Performantrac.com or 1-866-201-0580.
CMS also released its fiscal year 2015 report to Congress on the RAC program. Highlights for New Jersey include:
- There were $22.6 million in collected overpayments and $2.3 million in restored underpayments in New Jersey for FY 2015. For Region A in total, there were $83.1 million in collected overpayments and $7.8 million in restored underpayments.
- Overall in Region A, Performant had an improper payment identification rate of 10.9 percent.
- At the redetermination level of appeal (level 1), 72.1 percent of decided claims were overturned in favor of the provider in Region A. At the reconsideration level of appeal, the rate dropped to 23 percent, and at the administrative law judge level (level 3) it dropped to 8.1 percent. Performant’s overall rate of overturned denials at all levels of appeal was 52.1 percent.
