we want to formally thank you for joining us for this special event my name is alen Sigler I represent provider Outreach in education or po at WPS government Health administrators as part of the part A and part b Medicare administrative contractor or Mac for jurisdictions five and jurisdiction 8 we are pleased to partner with performant recovery to bring you this education and it's my pleasure to introduce our speaker roxan cookie has more than 18 years of Health Care customer service and project management experience she oversees multiple performant Health Care customer service teams closely monitoring performance to ensure outstanding customer service delivery for multiple commercial client contracts in addition to CMS rack region 1 region two and the national contract for region five so rockan please go ahead thank you very much Eileen I appreciate the introduction as we move through this um I again welcome everyone here uh continue to put your questions into the question box as we go and um we we will save those to the end and then and go through those uh as much as possible as Eileen said I do oversee multiple customer service teams that is my passion and we are certainly here to deliver the best experience possible so anytime that you have something that comes up otherwise I'm the first person that needs to know about that as we move forward I just want to uh put our disclaimer out there that the information in the presentation is current as of today but it is subject to change as required throughout the duration of the contract because things do change from time to time I'm sorry it didn't look it didn't uh go forward right there all right so for today the first of our three sessions we are going to review the scope mission and goals of the rack program we are going to spend time on the ADR letter how to request an extension and Technical denials we are going to cover uh the courtesy calls and contact information proper record submissions and record reimbursements and then we'll do the Q&A at the end so let's start with the scope of the rack regions performant is contracted with CMS to operate the recovery audit programs in regions 1 2 and five ctivity uh still has the rack program operations for Regions 3 and four and then here's a quick snapshot of the jurisdictions for the Nationwide Region 5 contract that we hold so we want to talk a little bit about the mission of the rack program why does it even exist uh Medicare introduced the rack program beginning in 2005 and it was to help identify by proper uh improper payments that were made by Medicare racks on behalf of CMS are going to go out they're going to request specific types of claims for review and then that audit program is designed to look for both underpayments and overpayments that may have been made so that Medicare can correct any of those incorrect payments made for eligible beneficiary Services based on the review determinations in this proc process we want to be transparent about what we are reviewing on the Rack website you can find the details of each review issue that the rack is approved to audit the recovery program must also be consistent all racks are required to audit the same Concepts follow the same set of audit review guidelines and abide by the same ADR limitation and look back period rules and I want to spend some time on accountability we know that the program obviously is holding providers accountable to proper billing and coding practices but what about the rack who holds the rack accountable well there's a couple of different ways that that happens the first way is that CMS monitors the first level Mac appeal overturn rate it has to be at or below 10% this is a strong indicator of how well the rack is applying the rules and regulations as they review claims and it's also an indicator that the racks the max are in sync with how they're interpreting those rules and regulations and we talk about these rates the mac and the rack uh in meetings in order to quickly address any outliers they may surface so this is one of our agenda topics racks are also quality monitored each month an independent third-party contractor for CMS performs audits on the very same audits that we have completed a quality rating of 95% or better is required so each region remember we have three regions uh they pull 200 audits each month for a total of 600 audits reviewed on the work that performant has completed and so you know when you're thinking about it from that provider perspective you know 25 audit seems like a lot maybe but the RS are getting 600 audits a month pulled and that is reviewed I did ask the program managers to share their accuracy rates with me before we did this presentation and and I'm honestly really proud to to share those numbers with you region one is sitting at around 9 97.5% region two is sitting at 99% accuracy and Region 5 is also at 99% accuracy rates so those Auditors out there are doing a really fantastic job if the r fails to maintain satisfactory performance in any of these areas corrective action may be taken by CMS and one of those corrective actions would be a reduction or even a stoppage of the audits that we are allowed to conduct so let's dive into the ADR components next the purpose of the ADR letter is to request medical record documentation to complete what is referred to as a complex audit ADR stands for additional documentation review going into detail on the letter the first page has information pertaining um to where we mailed the letter the date it was mailed and to whom we have addressed it and I want you to take note of the letter request ID I highlighted in green here anytime you call customer service they're going to ask you for the letter ID that you're calling about it's the quickest way for them to pull up that letter that you may have questions about or that you want to discuss an issue with in the next few sections of the ADR letter it's going to outline the look back period the good cause reasons for reopening the claim and that the rack must abide by the established ADR limits and ADR limits defined are the maximum number of claims that can be requested Within 40 uh single 45-day period so after the how many and why these claims have been requested the next section of this letter is going to tell you when the records are due and that you can call customer service and request an extension if you need one it also tells you what the consequences of not uh complying with the request will be which is a technical denial for non-compliance and we will cover technical denials and how to avoid them in more detail the next section of the letter is going to provide the record submission instructions what audit issue it is that we're requesting records for and then it's going to list specific claims that are requested for review the final pages of this letter are going to list the specific records at a minimum that should be included to support the review and remember you need need to send all documents that support how that claim was buil and coded and at the very end is what we call the bar code sheet and that is used for record separation when submitting your record packages so sometimes you need a little extra time what happens then if for any reason you need extra time all you have to do is call the rat customer service team and they will assist you with an extension typical extensions are 14 calendar days but if more time is needed just ask the rep to work with you explain why more time is needed and they will go through a process of getting you extra time uh if that's uh required make sure you have a place uh a process in place for rack related audits each request for records is time sensitive and it must be responded to and I want to spend a moment of time on technical denials as previously covered if an ADR letter is not responded to there is a process in which the claim will be denied for failure to comply with the request and this could result in a full takeback of the medicare payment by the Mac if for whatever reason a claim is technically denied Don't Panic you still have 30 calendar days from the date of that Tech denial letter to submit records it is important to note that additional extensions are not granted on claims that were technically denied for non-compliance they must be responded to within the 30 days or if not the Mac is going to be notified and once the Mac is notified performant cannot recall that claim back for review at that point you have to go through the appeal process with the max your records to them and have them review it in order to stop the recruitment so it is important to understand that performance does not want to do Tech denials so to help avoid Tech denials approximately 30 days after the ADR letter was sent if medical records have still not been received the performant customer service team is going to make a courtesy call and they want to confirm that you've received that record request it's also a good time during that courtesy call to request an extension if you think you're going to need one if the letter cannot be located the representative can fax or remail you a copy of that letter please note requests for letter copies should be requested on an exception basis we ask that you ensure that you have proper internal processes set up to manage rack rated letter letters I also want to mention that we cannot send letters via email as this is not a CMS approved method of transmitting documents that contain Phi so in order for the letter to be facted there are a couple of verifications that must be passed one make sure that adequate mailing time and routing time has passed which is typically 10 to 15 days if it's more than 15 days give us a call and we can get that letter faxed over to you at this time you must also confirm that the address we have on file is correct and updated if it is not and then third if you're requesting a letter of a copy of the letter be fact you must be able to confirm your NPI or tax ID number and this verification step is necessary to help protect Phi so we want to make sure to please have everyone responsible I for records request know that information additionally performant is going to post the date of the ADR letter on our portal which you can monitor at this time our portal does not contain copies of letters nor are you able to upload records through our portal it is a project that we have under development and very excited to to hopefully get that uh developed and put out there in the near future in order to efficiently respond to Rack ADR letters performance suggests building a response team who is the contact person or the designated Department that's going to handle your documentation request make sure that the address on file is correct and that the attention to section is filled out along with the correct phone number and fax number once letters are received in House at your location ensure that there's a process to Pro L route letters to the designated department or individuals that should be getting these documents I can tell you it's it's not an uncommon situation for the letter to have been delivered to the correct address and facility but somehow some way there's not an internal process where those letters are getting routed to the person who should be fulfilling those ADR requests given the time sensitive nature of these letters we want to stress the importance of having that accurate contact information on file incorrect contact information could result of in the misrouting of rack rated letters and then that can lead to those unwelcome technical denials if you need to update your contact information on file here's how to do it go out to the performant Rack website and then on the home landing page there is a click here button it's on the right hand side and it says update your contact information information when you click on that it's going to take you to a forms page which you can see a sample of right here we strongly encourage you to customize the addresses that you wish your letters to be mailed to and it's also important to note you can have one address for the medical record request and then you can have a completely different address that you want your review result letters and discussion decision letters to go to please make sure that the address is correct with your Mac as well so now that we have good contact information the letter is in the hands of the right person let's spend a little bit of time on proper record submission remember that bar code sheet that we saw earlier here's how you use it walking through creating a submission using example of three records requested the first step is to refer back to that list of Records requested in the ADR letter and gather those documents once gathered you want to make three copies of the barcode sheet for bundling purposes if we had four requests you would make four copies and so on next you're going to place a copy of the barcode sheet on top of each separate record set check the corresponding claim number and then package only those records for that claim into that one bundle in this example you would have three separately bound record submissions and each one should indicate with a check mark which records are contained within that bundle now that you have your records properly bundled you have to decide how you're going to submit them to the rack how are you going to get them over to us so you have three options that you can exercise when submitting records you can submit them electronically via esmd which is the recommended method you can mail them using uh a CD or put or on paper just paper copies and send them to us you can also send them via fax if that page volume is limited large faxes often time out and can end up as incomplete Transmissions or error out completely because they exceeded the maximum allowed megabytes please avoid sending records on the day of the deadline if for some reason you're not going to make the deadline or you're sending records probably within like 48 Hours of the due date it's imperative to call customer service speak with the representative and attain them short extension let them know like hey the records are on the way but my deadline is tomorrow or my deadline is two days from now doing that will help pre prevent Miss deadlines and Technical denials or things going to the Mac that you had on the way but they just crossed each other's paths and I do want to spend a little bit of time talking about esmd leveraging electronic document communication between your organization and us the auditing party can save a lot of valuable time you no longer have to wait on the mail routing time and if it's getting to the right person so until performant has a portal develop from which you can pull letters and submit records esmd is truly your best option we encourage you to engage with a health information Handler of your choice and take advantage of those electronic communication options and here is a list of the handlers available to you you can go out to that cms.gov website link that's here and you can get started today on that once you have set up with esmd there everything that you need to do with the rack you can do you can receive your ADR letters electronically you can submit your medical records electronically and you get a higher maximum record reimbursement you can receive your review result letters electronically and additionally you can also submit discussion period request as well through esmd CMS guidelines include clude the applicable reimbursement amount per page and a maximum amount per medical record it is possible that there are different amounts per page depending on the provider type and if the submission is paper CD fax or esmd the maximum payment amount to a provider per medical record will not exceed $27 for medical records that are sent via esmd there's that higher reimbursement rate we talked about if it's not sent via esmd the maximum uh medical record reimbursement rate will be $115 there is no requirement to invoice performant performant tracks all incoming pages and we will issue a check within 45 days of that record receipt if checks need to be mailed to a different address please call customer service with that information they do maintain a separate address file for mailing checks so believe it or not that concludes the end of session one today as a recap we covered the ADR letter how to request an extension how to avoid technical denials keeping your contact information updated how to submit records and record reimbursements we do have a session two that will be coming up and that date is 521 and I believe uh alen will have links out there and there will be information that will be posted on how to get signed up for session two and in that next session we're going to cover the different types of review uh audit result letters and then what to do when you get one if you happen to disagree with the audit outcome so before I turn this back over um I'd like to mention that on our performant Rack website in the supporting references section there is a frequently asked questions document and that document covers a just a ton of common questions that providers often ask so please check out that document when you have time available and I am now going to turn this back over for the question and answer segment of today's Outreach great thank you for that good information roxan I know I learned a few things too so it's really helpful we have gotten a couple questions um some of them were sent um earlier in the presentation so you probably did answer some of them but I'll go ahead and just ask them in the order in which they were sent in okay the first first one comes from Jasmine is it best to submit each patient medical record separately with a copy of the ADR letter or or does it have to be sent in bulk with all patients that are being requested together great question they need to be submitted as separate bundles so each claim is going to be its own record set um and and what happens is a lot of times if they're all bundled together in one big stack and the the correspondence team that uploads those records They may miss that there is a a record set change if it's you know 52 pages in and then the next change is I don't know 76 pages in and then the next page you know is 102 so yes please bundle those separately you can use you know a paper clip you can use um a a binder clip you can use uh rubber bands uh don't staple them it would be the only thing that I would ask of you most people use a rubber band unless they're just a really thin uh set of Records but please uh and then each record is uploaded in each claim in our our our audit system is um a standalone claim so that's why we ask for separate record submissions okay great um I'm G to scroll up here just to see the other questions um Holly asks is it necessary to send records if you believe the service just needs a coding correction yes please go ahead and still send in the records if um that is the case you will get a review result letter from performant um and then there's that 30-day discussion period waiting time and then when the file goes to the Mac you're going to get your demand letter at the point at which you get your demand letter that now reopens that claim for you so that you can make that correction and you will avoid the takeback because you're simply going in and making a correction to the coding but you have to wait for your demand letter first great thank you why are only facilities audited why aren't surgeons or Physician Offices audited they seem to bill whatever gets them paid and we bill off the operative report and ology report great question we do audit providers and Physicians and surgeons and Labs we audit everything we call those car claims carrier claims they are our physician Audits and we do a huge volume of physician audits in addition to our facility reviews so they are out there great I'll just add to elen if they want to know what those are go out to the performa uh website and go to the new issues and in the provider type column you'll be able to see which ones would be physician audits great great and thank you for that question Camy next question comes from Trish what is performance process as to how they're locating the topics they are auditing it seems very random and different from other contractors so our audits are not random um they are based on the issues that you will see out on the performant website go to the approved issues all of those issues are approved for by CMS vetted by CMS for us to audit against and CMS very closely monitors to make sure that we're not just doing one audit type only one issue only they make sure that we have a balance of audits across all those issues that we're approved to audit in order to make sure that we aren't just hitting one audit type all the time we have to have balance within our selections great so this kind of goes along with that um Deborah asks are the ADR letters sent monthly or randomly they are not random um they are on basically a 45 day cycle it may feel more random to you because you may get one every you know 70 you may get one at 70 days and you might get another one at 90 days and then but but it it is it is a 45 day cycle so you could have up to eight ADR request in a year because those 45 day cycles divide it out into 12 months is eight Cycles so we can never send more than the ADR limit within a 45 day period but we can never but we can go under that so you may not get eight eight ADR letters from us in a year you may get less than that but you will never get more than that all right thank you for that explanation um and I know you talked about this and I'm not sure when put this question in but it says performance portal is very limited is there any indication when they will update to have the capability to upload records check status and get results letters yeah definitely a paino and we recognize that we do have a development team that has gotten started on that developing phase for our CMS portal right now the portal does not contain any pH Phi information and in order to make it a much more robust system where now that it does contain that Phi information you can get those letters you can upload records it uh it has a like a completely new process and and system needs to be put in place I don't have any kind of estimated time frame for you um I I know everyone at perform it feels a sense of urgency around that it's a huge project that has been undertaken and um I it's not going to be a short term you know in two months you're not going to see something but you will see something um I just don't have a timeline to share with anyone yeah I think we're all excited about that so thank you me too um from Sharon what criteria is used to determine who gets audited so we do not Target providers when we go out and select claims we have this huge data set of of information claim information that CMS sends us monthly and we have algorithms that will go out and it is code driven so each one of those issues that you see out there on our website that were approved have Associated codes that are with them so we go out and we look for these codes that have been been build that have known High error rates in Billing and those are how selections are uh put together once those selections are put together we send them off to CMS CMS approves that selection file sends it back to perform it and then we send out letters great and then um we have a question from Nancy is there a way to check to see if a list ADR was sent out to the facility and we didn't miss it yes so the portal um even though it's not a super robust portal if you go out to our portal and you sign in using the I believe it's NPI driven so you get signed in and if you don't have the the the um sign in information or your password is expired just call customer service and they'll get all that reset for you but you can go out there and you can look and see if any adrs have been uh it'll have the date that the ADR was mailed out and then from there you'll be able to see in the next column over whether we've received medical records or not on that okay great and it looks like that's the last question question we've received as of now outstanding all right um if that's everything I I the everyone that's present today thank you for allowing performant to speak with you regarding the rack program and our processes uh there is more to come in the next couple of sessions and you know just remember we're here to help you navigate the Program help you get through all the requirements and anytime that you have questions please just call customer service or reach out to us via email and we will get a response to you um and if anyone has any questions that they thought of after this presentation send them to the uh info@ performant rat.com email and just say you attended today's presentation and you've got a question for Rox San and they will make sure and get that email sent over to me so I can uh get whatever it is that's on your mind uh those questions answered for you great and I want to thank you rockan for that great information we got a couple comments even in the chat um that it was a very good presentation um I do want to let everybody know that part two of this presentation um will be open for registration within the next few days um um we put the ball in motion to get that registration open just today and so you'll be seeing that soon so you can get even more in-depth information um be watching for that thank you for attending email it'll have a link to our survey and also your contact hours if you need those um I will email the presentation here just shortly in a couple minutes to everybody that was on the line um if you have any questions you have our email address also that we can help you and we look forward to your feedback and for having you join us on future events so thank you everyone this concludes our webinar and you can have um a good rest of your day and you can now disconnect