Revenue Cycle

Q&A with Debbie Mackaman: Recovery auditors and more

Recovery Auditor Report, March 8, 2012

1. What type of impact do you think the newly announced demonstration project for recovery auditor prepayment review will have on providers?

The actual impact won’t be seen until later this year since CMS had delayed this project and then recently announced that it is expected to begin on or after June 1, 2012.  In theory, it could reduce the number of appeals that providers would have to file when they disagreed with the recovery auditors’ (RAs) findings.  However at this time there are several things that remain unclear – what the focus areas will be, what the volume of claims may be or what the process will be if the provider disagrees with the findings of the prepayment review.  CMS’ intent is to “lower the error rate by preventing improper payments rather than the traditional pay and chase methods” with their focus primarily being on claims that have historically resulted in high rates of improper payments.

Comparing the recovery auditor program (RAP) prepayment to current prepayment reviews under the MAC or CERT, providers will be looking at a delay in payment during the review process and hospitals from the 11 states that will be participating in the demonstration project should begin to consider the ramifications. CMS has not indicated that certain hospitals will be included or excluded so prospective payment system (PPS) hospitals and critical access hospitals (CAH) should monitor the roll out of this project.

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