Is Anyone Listening? CMS Appoints Provider Relations Coordinator to Field Gripes about RACs

The CMS announced this week the appointment of a Provider Relations Coordinator “to help increase program transparency and offer more efficient resolutions to providers affected by the medical review process.” The “medical review process” garnering the most attention these days is the Recovery Audit Contractor (RAC) program. RACs are the target of ongoing criticism along with pleas to fix a system so backed-up with appeals that Congress placed a moratorium on the program.

According to the statement issued by CMS, questions regarding specific claims should continue to be directed to the RAC responsible for the audit and review. Apparently, the Provider Relations Coordinator will field concerns about “larger process issues,” such as a RAC’s failure to follow program requirements and guidelines.

Provider Relations Coordinator seems to be the CMS equivalent of a Customer Service department in the commercial sector. Which brings me to the question: What does customer service actually do if not empowered to correct the customer’s specific problem? I suspect the typical customer services representative listens to everything from constructive suggestions to long rants laced with venomous jibes at the company. Trained to stay calm, the representative tries to placate the customer: “We regret that your experience was not satisfactory.” Or, “Your opinion and satisfaction are very important to us.”

I want to believe that customer service departments actually document the complaints and concerns to pass along to company management, who, in turn, take the time to review and implement necessary change. Of course, I can choose not to do business with a company that does not heed customer dissatisfaction. Providers, on the other hand, are stuck with RACs.

Finding someone to listen at CMS has not been so much a challenge as finding someone at CMS who will fix the RACs.

In the meantime, health care providers may contact Provider Relations Coordinator about RAC review process concerns/suggestions at RAC@cms.hhs.gov and MAC review process concerns/suggestions at MedicareMedicalReview@cms.hhs.gov.

If you would like further information about RACs, please contact Thomas E. Jeffry Jr., Linda A. Baumann, or the Arent Fox attorney who normally handles your legal affairs.