Corporate Compliance

Q&A: What happens if the recovery auditor does not meet the 60 day requirement?

Compliance Monitor, February 2, 2011

Q: What happens if the recovery auditor does not meet the 60 day requirement?

A:  The recovery auditors have 60 days from receipt of the medical records to make a determination and issue a written notice of that determination to providers. The 60 day requirement can be found in the Statement of Work used in the Recovery Audit Program. Lack of adherence to the 60 day requirement of notification does not negate the improper payment finding or the recoupment of the improper payment by CMS. Lack of adherence to the 60 day requirement is a performance issue between CMS and the recovery auditor.

This question and answer appear in the Frequently Asked Questions section of the CMS website.

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