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CMS ANNOUNCES CHANGES IN RECOVERY AUDITOR (RA) PROCEDURES AND “A PAUSE IN OPERATIONS”

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CMS ANNOUNCES CHANGES IN RECOVERY AUDITOR (RA) PROCEDURES AND “A PAUSE IN OPERATIONS”

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:


“The changes 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.”

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

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



 

 

 

 

 

 

 

Posted in: | Tags: CMS , DENIALS AND APPEALS , RECOVERY AUDIT CONTRACTORS , ADMINISTRATORS , MEDICARE , health care reform , PHYSICIANS | Comments (0) | View Count: (11230)

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