Revenue Cycle

CMS releases details of recovery auditor prepayment review demonstration

Medicare Update for CAHs, January 11, 2012

On November 15, CMS announced that it will launch a number of demonstration programs starting in January 2012, one of which is a 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 was 8.6%, which translates to roughly $29 billion, 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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