Skip to Main Content
Thought Leadership

A Command Performant(s): RAC Audits on the Rise



April 17, 2024
Listen to the podcast

Related Industry:


Related Service:

Hospice & Palliative Care 


Recovery Audit Contractors (RACs) have played a relatively limited role in the hospice space, often overshadowed by UPICs, SMRCs, and Center for Program Integrity audits. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki talk about a recent wave of record requests issued by a RAC named Performant that focus on GIP and Continuous Home Care, and some ideas about how to respond.

Read the Transcript

This transcript has been auto generated

00;00;05;01 - 00;00;27;11
Meg Pekarske
Hello and welcome to Hospice Insights: The Law and Beyond where we connect you to what matters in the ever changing world of hospice and palliative care. A Command Performant(s): RAC Audits on the Rise. Quirky name to our title, but performant is the name of the contractor right Bryan?

00;00;27;20 - 00;00;41;16
Bryan Nowicki
Yeah, Performant is the recovery audit contractor who's recently been sending out requests to hospices all over the country. So a command performant(s) is one way to think of it.

00;00;41;26 - 00;00;53;09
Meg Pekarske
That sounds like our our when we came up with our EEE ... excellent, efficient, extraordinary, whatever. What was our, like, innovative.

00;00;53;10 - 00;00;55;26
Bryan Nowicki
EEEI, the hospice. Yeah.

00;00;55;26 - 00;01;05;10
Meg Pekarske
Yeah. Our hospice cry. That really motivated people on the hospice team that. Oh, yeah, you know, you rah rah people.

00;01;05;10 - 00;01;08;06
Bryan Nowicki
The team still loves it when we bring that out during meetings.

00;01;08;10 - 00;01;31;18
Meg Pekarske
Yeah, exactly. So but Performant is the contractor who and so we're seeing RAC audits and these are post payment review. And I think most of the things are seen as focused on continuous home care and GIP.

00;01;31;19 - 00;01;58;29
Bryan Nowicki
Yeah, you could tell it's you'll get a multi-page letter, you know 99% is boilerplate. We've seen a lot of these letters but but ultimately, you know, they'll they'll have a part of the letter that has a headline or a title that will tell you whether it's GIP or continuous home care. And of course, when they identify the patient and the claim that they want records for, you'll be able to tell for yourself from your own records.

00;01;58;29 - 00;02;29;06
Bryan Nowicki
Is this really continuous home care and GIP? And the good news has been lately that these are focused on one, maybe two patients and just one claim per patient, which is not too surprising given the elevated levels of care. It's I think would be unusual to have somebody on GIP across several claims. So they're somewhat limited in their scope, which is a nice change of pace in the audit world from the CPI.

00;02;29;06 - 00;02;32;12
Bryan Nowicki
And UPIC and OIG audits that we're doing now?

00;02;32;13 - 00;03;03;00
Meg Pekarske
Absolutely. I think that when people are getting these letters, as you said, it's usually asking for one patient. They might get another letter down the road for another patient, but it's never like a, you know, ten patient poll or something like that, which is helpful. But I think that any time you talk about auditors, everyone's question is while they get paid, you know, like on a commission basis, right, they are a contingency basis.

00;03;03;00 - 00;03;29;23
Meg Pekarske
Like they get a portion of what they recoup. And I think most of the time that's that's not a one for one like that. But RACs recovery audit contractors are ones that are paid on a contingency. Now due to litigation around how RACs performed audits for hospitals how they're paid that and how many they records they can pull and stuff.

00;03;29;23 - 00;03;58;03
Meg Pekarske
There has been some adjustments made to that, but these are the contractors that you could argue have an incentive to deny claims. However, I think the experience that we've had working with clients on these is that there is a discussion session that you can use which has been very helpful to people and they have actually made changes and turned things that were denials or a haircut on.

00;03;58;14 - 00;04;31;16
Meg Pekarske
Like some people have gotten haircuts on their units for continuous care because they might have overlooked some documentation about units and they've, you know, reversed that. And so I think of all of the news there is to share about audits, I think these have been refreshingly small, but also that they listen and that you might not have to go through the whole appeal process because you do have this ability to have a conversation with someone.

00;04;32;00 - 00;04;58;16
Bryan Nowicki
Yeah. And it is that is such a benefit not not just to providers, but I think to Medicare to have these discussion sessions, these discussion sessions come up in a few contexts. And we always want to take advantage of them. Like True Smirk appeals, what we call true smirks. There's a discussion and education session there before they issue their final findings.

00;04;58;29 - 00;05;41;16
Bryan Nowicki
And we've gone into those. And when you talk through the issues with a representative, you know, sometimes they will listen and they will realize they've made a mistake and correct it in their final findings. Same with Performant, where you can actually talk through things. I think it was key to see one of the quicks that had a pilot telephone discussion project a few years ago where we actually talked with someone at the reviewer and were able to before we had to invest more in appeals and go to the ALJ, we're able to kind of talk through and and reach some reasonable, more reasonable conclusions or have the auditors reach some more reasonable conclusion.

00;05;41;16 - 00;06;03;27
Bryan Nowicki
So, you know, I think that's a solution that should that should be available in new pick audits and in all kinds of audits because it is helpful. And for these performant reviews, they're specific in the letter, you'll see in the letter, they do reference this discussion session where there's an opportunity to discuss and an opportunity to submit more documents.

00;06;03;27 - 00;06;27;01
Bryan Nowicki
So absolutely take advantage of that. And for that reason, we don't, you know, advocate or encourage, recommend that clients submit anything more than just the records requested at the initial stage, see what the results are, and then use that discussion session to to do some more advocacy, submit more documents to try to defend your position.

00;06;27;12 - 00;07;08;14
Meg Pekarske
Well, I guess my one benefit with these audits is that essentially chipping continuous care are so underutilized generally. And so then you're going to audit the people who are actually providing all four levels of care because I mean, I think that that's sort of the challenge with all of these audits. Right, is like the CPA audits that are focused on really long length of stay, it's like, well, we're just going to pick your tail and unless you, you know, discharge everyone that's been on service over six months, you're going to obviously have a tail.

00;07;08;14 - 00;07;37;01
Meg Pekarske
And same with this. Like if you're really doing all levels of care, of course you're going to provide continuous care in GAAP. And so again, I just think some of these audits really have chilling effects and the way people some people could respond by how you stay underneath the radar screen, as I never provide all four levels of care, I, you know, discharge people if they, you know, outlive a six month prognosis, even though they might be eligible.

00;07;38;04 - 00;08;11;02
Meg Pekarske
Now, you'd hope that that would flag from a data analytics standpoint through the high live discharge rate. Right, if you're going to try to game the system that way. But but still, I just think it's part of this larger audit trend is just I think you're pounding people who are actually providing the benefit and not trying to necessarily game the system here because continuous care is really a hard level of care to to provide.

00;08;11;02 - 00;08;40;06
Meg Pekarske
And I think people should be encouraged to do that and staff for that. I mean, especially with all of the staffing shortages people are having right now, I mean, to have a team devoted that can be on call to do this is, I think, a really wonderful thing. And so I do think in general, these audits have resulted in, you know, not as many denials as everything else we've been talking about in the audit land.

00;08;40;06 - 00;08;55;16
Meg Pekarske
And and that, as you said, Brian, that opportunity to discuss has been really critically helpful to to hopefully, you know, not having further review and payment denials and whatnot.

00;08;55;25 - 00;09;21;20
Bryan Nowicki
Yeah. And you know, the one of the reasons why we wanted to do this podcast was it just seems that these are becoming more prevalent. I've had, you know, many calls just in the past month about hospices getting the performant letter, which is more than that I've seen in all the years I've been doing this. So, you know, look, look in the mail for these things, they seem to be increasing in prevalence.

00;09;21;20 - 00;09;33;08
Bryan Nowicki
Thankfully, they're not as hardcore as other audits that are out there, but you still got to take them seriously with continuous home care GAAP, the dollars add up and we know hospices need to fight for every dollar they can get.

00;09;33;15 - 00;09;38;18
Meg Pekarske
Absolutely. So. All right, Brian, audit, audit, audit, garbage.

00;09;39;02 - 00;09;40;00
Bryan Nowicki
Some of.

00;09;40;06 - 00;09;45;09
Meg Pekarske
That. What is it, Mr. Robotic What was that from the eighties?

00;09;45;22 - 00;09;46;16
Bryan Nowicki
Mr. Roboto.

00;09;46;18 - 00;09;51;05
Meg Pekarske
Yeah. Mr. Roboto. So I'll tell you, Mr. Audit.

00;09;51;19 - 00;09;54;24
Bryan Nowicki
Domo arigato.

00;09;54;24 - 00;10;05;09
Meg Pekarske
Yes. Oh, we're dating ourselves. But anyway, our listeners are probably our age anyway, so they’ll get it. But Mr. that's what I'm going to call you. Mr.

00;10;05;09 - 00;10;14;01
Bryan Nowicki
ACHO Yes, I do. I ditto. I need to workshop that. We'll have them down exactly. Next podcast. We'll have it down.

00;10;14;01 - 00;10;17;04
Meg Pekarske
Yeah. So well thanks as always, Bryan.

00;10;17;16 - 00;10;20;23
Bryan Nowicki
Yep. Thank you, Meg.

00;10;20;23 - 00;10;38;06
Meg Pekarske
Well, that's it for today's episode of Hospice Insights: The Law and Beyond. Thank you for joining the conversation. To subscribe to our podcast, visit our website at or sign up wherever you get your podcasts. Until next time, may the wind be at your back.