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Recovery Audit Contractors: 3 Year Demonstration Project

Trailblazer is Offering Web-Based Educational Sessions

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Recovery Audit Contractors: 3 Year Demonstration Project

November 7, 2005

1:00 -3:00 PM (Eastern Time)

The Centers for Medicare & Medicaid Services (CMS) recently implemented a new demonstration project using Recovery Audit Contractors (RACs) as part of CMS’ efforts to ensure accurate payments. Under the conditions of this three-year demonstration project, the RACs will review Medicare claims to identify improper Medicare payments that have been made to healthcare providers and that were not detected through the prepayment review process. The RACs will review claims processed in the states of California, Florida and New York.

CMS maintains ongoing efforts to ensure that providers have the information they need to bill correctly, and to avoid improper payments. Education and training resources on the CMS professional website (www.cms.hhs.gov) include a customized provider web portal (www.cms.hhs.gov/providers), new Medicare Learning Network educational products and training guides (www.cms.hhs.gov/medlearn), regular “Medlearn Matters” articles explaining new program policy billing procedures (www.cms.hhs.gov/medlearn/medlearnmatters), and enhanced Frequently Asked Questions.

CMS is holding this Special Open Door Forum to provide a broad audience of health care providers, suppliers, and beneficiary advocates, with an opportunity to review the purpose and scope of this demonstration project, to allow for further public discussion on the roles and responsibilities of the RACs, and to give a better understanding of how they will conduct their operations during this three-year demonstration. The forum will begin with an update of the RAC demonstration, and will then transition into an open question and answer period with CMS policy experts and with the RAC contractor representatives from the three states.

We look forward to your participation.

Open Door Participation Instructions:

Dial: 1-800-837-1935 & Reference Conference ID 1661424:

Note: TTY Communications Relay Services are available for the Hearing Impaired.

For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html.

A Relay Communications Assistant will help.

ENCORE: 1-800-642-1687
“Encore” is a recording of this call that can be accessed by dialing 1-800-642-1687 and entering the Conf. ID # 1661424.

The recording begins November 8th, and expires after 4 business days.

For automatic emails of Open Door Forum schedule updates (Listserv registration) and to view Frequently Asked Questions please visit our website at: www.cms.hhs.gov/opendoor.

Trailblazer is Offering Web-Based Educational Sessions

We thought you’d be interested to know that Trailblazer is offering web-based educational sessions that include an overview of the DDE application as well as an overview of Section 1011 and instructions on the enrollment process.

Training session dates and times are currently scheduled are as follows:

Oct. 28, 2005 - 1p.m.- 3 p.m. (CT)
Nov. 1, 2005 - 1p.m.- 3 p.m. (CT)
Nov. 2, 2005 - 1p.m.- 3 p.m. (CT)
Attendance is limited, and registration is required. To register for these training sessions or obtain more information, please visit the TrailBlazer Section 1011 Calendar of Events. If you experience any problems with registration, please contact Trailblazer’s Section 1011 Customer Service Call Center at (866) 860-1011.

Trailblazer’s Explanation of DDE. Direct Data Entry (DDE) will be accomplished through GPNet On-line Services. Access to On-line Services is made available using a dial-up connection through AT&T Global Network Services. There is a $3 per month fee plus a connection time charge. For metropolitan areas where network access is a local call, the connection charge is $4.35 per hour. For areas requiring the use of a toll-free 1-800 number, the charge is $5.50 per hour. Most major cities have local dial-up access.

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