Recovery Audit Program Procurement Update and Transition

Today, the Centers for Medicare & Medicaid Services (CMS) is posting an update to its website regarding changes to the Medicare Fee-For-Service Recovery Audit Program. CMS is currently in the procurement process for the next round of Recovery Audit Program contracts. We plan to award five regional recovery auditor contracts through open competition, which is already underway and should be completed in the coming months. To help facilitate the transition, there will be a transition phase that includes a cease of active work by current recovery auditors to allow current audits to be completed before adding new audits to the process. Once new contracts are awarded we anticipate audits will resume and the new Recovery Auditors will be able to review most claims that were paid during the pause. This pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program. For example, CMS is reviewing the Additional Documentation Request (ADR) limits, and the timeframes for review and communications between Recovery Auditors and providers. In an effort to address provider concerns, CMS is announcing several changes to the Recovery Audit program effective with the new contract awards. These changes can be found at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/?redirect=/recovery-audit-program/ CMS is committed to constantly improving the program and listening to feedback from providers and other stakeholders. Providers should note the important dates below: * February 21, 2014 is the last day a Recovery Auditor may send a post payment Additional Documentation Request (ADR) * February 28, 2014 is the last day a MAC may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration * June 1, 2014 is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment CMS will continue to update this website with more information on the procurement and awards as information is available. Providers should contact RAC@cms.hhs.gov with additional questions. Moratorium on Recovery Audit Reviews of Inpatient Status For 1-Year Period CMS also recently issued an update to its Inpatient Hospital Prepayment Review "Probe & Educate" review process (or "2 Midnight" policy) on January 31, 2014. As part of this update, CMS announced that Recovery Auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through October 1, 2014. Medicare Administrative Contractors (MACs) will continue to conduct prepayment probe and educate reviews through September 30, 2014. More information regarding this announcement is available at: http://cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medical-Review/InpatientHospitalReviews.html