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Rehab Documentation Reviews and RACs: Who Ate My Fax?

July 18, 2013 3 Comments

Surprised woman with smoking copierHave your faxes not been getting through to the Recovery Auditors (RACs)?  You are in good company, and by the end of this post you’ll have a surefire way to securely get your records to the RAC.  RAC manual medical review of therapy claims over the $3700 thresholds are underway and providers are getting a flavor for post payment review of claims for which they have already been paid.  Providers in the 11 states that are part of the RAC CMS Prepayment Demonstration project are having claims reviewed on a prepayment basis.  So what is the scuttlebutt from the provider community?  Here is a sampling of some of the comments that I have received from providers – and funny how the panic button seems to be all about the fax button:

  • “I have spent all afternoon faxing responses to our RAC for 14 ADR requests and not one has gone through. Our fax machine is set up to make 5 attempts to transmit and then it results in a failure. I’m not sure if you want me to stay and keep trying or if you think that I could try again tomorrow. Unfortunately the responses are due today. I have all of the fax error pages to prove that I tried to deliver these according to their deadline. Sorry to bother you with this but I’m concerned. Thank you!”
  • “MAC ‘timed out’ claims from 3/27, 29 and 4/1, 3, 5 and 8. This, per MAC, is because we didn’t respond to the ADR’s, which we did via fax on numerous occasions. The denial code is “N102 records not received”. I have fax logs and long distance records showing that we faxed our RAC multiple times with the responses.
  • We did submit this via fax in May.  However, even though we had the tracking number for the fax, they were never able to find the information that we had faxed and just this week they finally got back to us and asked us to re-submit the claim via fax.

Therapy providers got accustomed to faxing during the 2012 4th quarter manual medical review process.  Now that the Recovery Auditors (RACs) are in charge – they actually prefer that you submit information to them electronically – via digital media such as DVD or CD or via esMDElectronic Submission of Medical Documentation, a CMS initiative, has been available since late 2011, and most MACs and RACs participate in the in program and accept records via esMD.  Unfortunately the MACs would only accept mail or fax in the 2012 manual medical review.  CMS has approved numerous vendors and health information handlers in the program, and it is up to providers to contract with one of the vendors.

CMS has provided a list of esMD vendors on their website, and MEA has recently offered a small provider discount to the rehab industry.  Grab your calculator, figure the cost of printing medical records, sending them via fax (likely multiple times), anxiously await faxed receipt (which apparently may not mean much according to feedback above), checking back with the RAC to see if they received records, and starting the process again.  If you are mailing via certified mail consider the cost of record preparation, packaging, mail costs and any time in transport to the post office.  (The green certified -signed receipt card, may also not mean anything!).  With esMD you can prepopulate your patient list in a HIPAA compliant fashion, securely upload documents and be assured of transmittal and receipt all for a cost that is likely to be less than all the faxing and certified mailing, with the added bonus: you can sleep at night.  If you would like more information about MEA and the discount they have offered to small rehab providers send me an email or inquiry.

Don’t let your faxes go up in smoke!

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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