Your Internet browser is outdated and cannot run this website. In order to view this site, and to protect your computer, please click to upgrade to a modern web browser of your choice:

Google Chrome or Mozilla Firefox

(Worry not– it's quick, safe and free, and you won't regret it!)

Share This:
     

On December 30, 2014, the Centers for Medicare & Medicaid Services (CMS) announced new Recovery Audit contracts and updates to the Recovery Audit Program. The changes will reduce provider burden and increase transparency in the program.

Key updates to the Recovery Audit Program include:

  • The look-back period for patient status reviews is limited to 6 months in cases where the hospital submits the claim within 3 months of the date of service;
  • Additional Documentation Requests (ADR) limits will be based on providers’ compliance with Medicare rules, corresponding with a provider’s denial rates;
  • ADR limits will be diversified across all claim types of a facility;
  • Recovery Auditors will not receive a contingency fee until after the second level of appeal is exhausted;
  • Recovery Auditors must wait 30 days prior to sending the claim to the Medicare Administrative Contractor for adjustment to allow for a discussion request; and
  • Recovery Auditors must maintain an overturn rate of less than 10 percent at the first level of appeal, or will be subject to a corrective action plan.

A list of the improvements to the Recovery Audit Program is available at:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/RAC-Program-Improvements.pdf.

Centers for Medicare & Medicaid Services. “Recent Updates.” 14 Jan. 2015

<http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html>.

Centers for Medicare & Medicaid Services. “Recovery Audit Program Improvements.” 30 Dec. 2015

For information on responding to government auditors, click here.

Share This: