National O&P RAC Contract on Hold…….For Now

Stop signLess than two weeks ago, AOPA’s Take announced the award of the contract to serve as the single, national RAC auditor for all Medicare DMEPOS, home health, and hospice claims to Connolly Healthcare, LLC. On January 6, 2015 a formal award protest was filed with the Government Accountability Office (GAO) by Performant Recovery, who currently serves as the Jurisdiction A RAC auditor. The GAO has added Performant’s protest to its official docket and estimates that a ruling will be made by April 6, 2015.

The protest of the award of government contracts is not an unusual occurrence and actually happens quite regularly. The immediate result of the protest filing is that Connolly Healthcare, LLC will not be permitted to begin work as the national RAC auditor for DMEPOS, home health, and hospice claims until the Performant Recovery protest has been resolved. While the protest is being resolved, the existing four regional RAC auditors will be permitted to continue to perform RAC audits on DMEPOS, home health and hospice claims.

AOPA’s take on this development is that the protest filed by Performant Recovery does not represent a delay in RAC audits, but rather a shift in who is performing them. As mentioned above, the existing four RAC auditors, including both Connolly Healthcare, LLC and Performant Recovery have been authorized to continue to perform RAC audits on DMEPOS, home health and hospice claims until the protest is resolved. The protest will delay many of the improvements to the RAC audit program that were scheduled to be implemented with the award of the national RAC contract to Connolly Healthcare.  Unfortunately, these improvements will now be delayed until the protest is resolved by the GAO.

AOPA will continue to monitor this situation closely and report any updates as they occur.

AOPA’s Take. Where you go……….when you need to know!