Health Information Management

Recovery Auditors remain in the news

HIM-HIPAA Insider, April 15, 2013

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The Recovery Auditor (RA) program is alive and well judging by the number of news items popping up recently. Two RAs added new issues, CMS changed the threshold for document requests, and Congress is still considering revamping the program.

Performant Recovery added five new issues to its CMS-approved list for providers in Region A. Performant Recovery will be scrutinizing use of modifier –GZ for physician/nonphysician practitioner claims and ambulance service provider.
The other issues for physician/nonphysician practitioner claims are:
  • Maximum units for nerve conduction studies
  • Doxorubicin hydrochloride
For ambulance service provider, Perfomant also added ambulance services billed with non-covered origin and destination modifiers.
In Region C, Connelly added 20 new issues to its list, including:
  • Five for carrier claims
  • One for skilled nursing facility claims
  • Three for outpatient claims
  •  Eight for medical necessity claims
  • Three for home health claims
CMS posted revised guidelines for provider additional documentation request limits and supplied additional documentation limits  on its website April 4. The new guidelines become effective April 15.  
Meanwhile, Congress is still considering the Medicare Audit Improvement Act of 2013, which was reintroduced in March. The act aims to improve the performance of Medicare audit programs by implementing financial penalties for certain compliance failures.

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