CMS puts recovery audit program on temporary hold

The Centers for Medicare & Medicaid Services (CMS) has found one way to reduce the backlog of cases appealing deficiency decisions of payment denials: Stop the recovery audit (RA) program altogether until the auditors and judges can catch up.

“It is important that CMS transition down the current contracts so that the recovery auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts,” CMS said in an announcement released Tuesday. “In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare recovery audit program.”

The announcement comes on the heels of a forum held last week by the Office of Medicare Hearings and Appeals, which sought suggestions for how to tackle the surging number of appeals cases. Much of the government’s presentation at the forum centered on ways to make the process more efficient, including revamping the RA contractor processes themselves.

For now, CMS has placed the following date restrictions on auditor activities:

• Feb. 21 is the last day a recovery auditor may send a postpayment additional documentation request (ADR).
• Feb. 28 is the last day a Medicare administrative contractor (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.

CMS will continue to update [here] with more information on the procurement and awards as information is available. Providers should contact RAC@cms.hhs.gov for additional questions.

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Pamela Tabar

Pamela Tabar was editor-in-chief of I Advance Senior Care from 2013-2018. She has worked as a writer and editor for healthcare business media since 1998, including as News Editor of Healthcare Informatics. She has a master’s degree in journalism from Kent State University and a master’s degree in English from the University of York, England.