CMS Prepares to Launch the Recovery Audit Prepayment Reviews

The Centers for Medicare & Medicaid Services (CMS) recently launched the Recovery Audit Prepayment Review Demonstration on August 27, 2012, to continue through August 26, 2015. The demonstration enables the Medicare Recovery Auditors to review medical claims that frequently lead to incorrect payments before the payments are issued. In this demonstration, the Recovery Auditors will focus their prepayment reviews on 11 states. These states include seven that are at high risk for provider fraud and error: Florida, California, Illinois, Louisiana, Michigan, New York, and Texas. The following four states are included in the demonstration because they have a significant number of short inpatient stays: Missouri, North Carolina, Ohio, and Pennsylvania.

In the initial phase of the demonstration, the Medicare Administrative Contractors (MACs) will send out requests for documentation. Providers will have 30 days to submit the requested records. The Recovery Auditors will review the information, and respond with payment requirements and a detailed report within 45 days.

“Recovery Audit Prepayment Review.” August 10, 2012. Centers for Medicare & Medicaid Services. 17 Aug. 2012. <http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/RAC-Prepay-Review.html>. Centers for Medicare & Medicaid Services. “Recovery Auditor Prepayment Review Demonstration: Provider Outreach and Education.” Open Door Forum Presentation. 8 Aug. 2012.