The initial 3 year Medicare Fee for Service (FFS) Recovery
Auditor Demonstration is in conclusion. Medicare is in the process of attaining
new contracts as well as establishing some changes to policy.
The last day Recovery Auditors may send a post-payment
Additional Documentation Request (ADR) is February 21, 2014 and February 28,
2014 is the last day a MAC may send prepayment ADRs for the Recovery Auditor
Prepayment Review Demonstration. June 1 is the last day a Recovery Auditor may
send improper payment files to the MACs for adjustment.
In response to industry feedback, CMS announced 5 changes to the Recovery Audit Program:
1. Recovery Auditors must wait 30 days to allow for a discussion before sending the claim to the MAC for adjustment. Providers will not have to choose between initiating a discussion and an appeal.
2. Recovery Auditors must confirm receipt of a discussion request within three days.
3. Recovery Auditors must wait until the second level of appeal is exhausted before they receive their contingency fee.
4. The CMS is establishing revised ADR limits that will be diversified across different claim types (e.g., inpatient, outpatient).
5. CMS will require Recovery Auditors to adjust the ADR limits in accordance with a provider’s denial rate. Providers with low denial rates will have lower ADR limits while providers with high denial rates will have higher ADR limits.
The AHA NEWSNOW
in their daily report stated:
are small steps toward addressing significant hospital concerns with the
administrative burden caused by the RAC program, but do not address lengthy
delays in the RAC appeals process or discourage RACs from making inappropriate
denials in the first place. AHA will continue to urge CMS to address those
concerns, and Congress to enact reforms contained in the Medicare Audit
Improvement Act (H.R. 1250/S. 1012). AHA members today were sent a Special
Bulletin on the planned contract changes, and will receive updates as
additional information is available.”