Revenue Cycle

CMS releases details of recovery auditor prepayment review demonstration

Recovery Auditor Report, December 29, 2011

On November 15, CMS announced that it will launch a number of demonstration programs that are set to begin in January 2012, one of which is its recovery auditor prepayment review initiative.  On December 21, CMS held a special open door forum to further discuss the program.

Each year as part of its financial reports, CMS produces an estimate of its improper payments in the Medicare program. In fiscal year 2011, the rate of error in the Medicare program was 8.6%, which translates to roughly $29 billion in error, according to George Mills, director of provider compliance group at the office for financial management at CMS, who spoke on the call.

The goal of the prepayment recovery auditor demonstration, as stated on the open door forum by Amy Cinquegrani, Division of Recovery Audit Operations at CMS, is to prevent improper payments before they are made and to thereby lower this error rate.

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