Hospice RAC Audits Coming to Region C

Hospice Claims to be Audited.

Recently, Connolly, the CMS Recovery Audit Contractor for Region C announced it has received approval for the first audit of hospice claims.  The audit will only review claims up to three years prior and will confirm that correct and active Core-Based Statistical Areas (CBSA) codes were used.

Providers in Region C* will be selected at random and there are no guidelines to determine which providers will be selected for review.  Region C includes: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico and U.S. Virgin Islands.

CBSA codes are used to help indicate the location of service for hospice providers and is typically determined by the county in which the service is provided.  CMS posts a Wage Index annually to update CBSA codes.  You can find a current listing of active CBSA codes and wages on the National Hospice and Palliative Care Organization website.  You should also verify with your software provider that they update your system with the correct Wage Index each year.

When an audit issue has been approved by CMS, as has happened now, a provider that is being audited will receive a demand letter from the RAC.  The RAC will then give the provider an opportunity to discuss the determination with the RAC. If the provider agrees with the RAV’s determination, they can pay by check, allow recoupment from future payments or request and apply for an extended payment plan. If the provider does not agree with the determination, they can appeal.

This is the first of likely more RAC audits to come that specifically address hospice claims.  To keep up with the latest news about RAC audits and more, be sure to subscribe to our blog.