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Recovery Audit Contractor Reminders

Did you know that Performant is now the RAC for all of National Government Services Part A and Part B lines of business in Jurisdiction 6 and Jurisdiction K?

As part of the audit process, Performant may request specific items or complete records to support the billing and coding of the claim(s) under review. Performant has informed us of a large increase of providers who are not returning the documentation requested for review, more prominently for our J6 providers.

As a reminder, if you receive a request for additional information from the RAC, it’s important that you return the information as requested within the time frame noted by the RAC.

When requested records are not received, the case is automatically found unfavorable, the service(s) are denied and recoupment of paid services occurs. As a result, the provider would need to initiate an appeal and continue through that process by submitting necessary documentation, which can be time consuming and costly for your organization.

To avoid unnecessary delays and potentially incorrect findings, submit the documentation requested to the RAC to support the billing and coding of the claims under review within the requested time frame. You may submit records via esMD, CD/DVD, or paper methods. Send one complete submission of records as the audit time frame begins upon receipt of any record related to the review. Do NOT send multiple submissions of records. To learn about esMD, visit Electronic Submission of Medical Documentation (esMD) | CMS.

Additional information and provider resources are located on Performant’s website. From this site you may access information specific to JK (Region 1) and J6 (Region 2). Performant also offers a secure provider portal. Visit PERFORMANT to learn more.

Posted 5/30/2024