Enterprise IT Solution Development Aids Centers for Medicare in Implementing Recovery Audit Management Tool and Database

Client Success Story | Enterprise IT Solution Development Aids Centers for Medicare in Implementing Recovery Audit Management Tool and Database.

CLIENT CHALLENGE

The Centers for Medicare and Medicaid Services (CMS) requires a system to assist with the oversight and management of Recovery Audit Contractors (RAC). Each year these contractors review millions of Medicare claims resulting in identification of overpayments more than $1B. The CMS audit management tool must automate the workflow process, incorporating frequently changing business rule controls with defensible accuracy and great efficiency.

THE SOLUTION

The CMS RAC Data Warehouse (RAC DW) was custom developed to provide this functionality, with ongoing evolution and enhancements to keep pace with CMS’ changing requirements.  As a member of the Koniag Services, Inc. (KSI) team, Arlluk understood that the only way to succeed was to apply Agile practices to an established environment originally conceived and delivered using more traditional methods.  There have been over 30 major releases of RAC DW, and for the past several years a new release is deployed to production every quarter. The team migrated the system to a FedRAMP-approved Cloud and implemented a set of interfaces that allow integration of RAC DW with other CMS systems to improve the quality of the data.

THE VALUE

Applying Arlluk’s Hybrid Agile Framework to the legacy environment has significantly improved RAC DW agility in response to frequent changes to CMS Program requirements and subsequent releases.  It has further improved throughputs, lowered TCO, and improved stakeholder experience.