Tuesday, May 27, 2014

Recovery Audit Update

Dan Ciolek

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) provided an update on the status of the CURRENT Recovery Audit Contractor (RAC) activities after June 1, 2014. Per the CMS website:
  • The last day that Recovery Auditors may send claim adjustment files to the Medicare Administrative Contractors (MAC) is June 1, 2014. 
  • As of June 2, 2014, only claim closure files may be sent to the MACs, by the Recovery Auditor.
  • Because no additional reviews will occur under the current contracts, current Recovery Auditors will not be required to update the “New Issue” (“Approved Issue”) portion of their websites, as of June 2, 2014. 
  • However, Recovery Auditors shall continue to update the “Claims Status” portion of their provider portal, in a timely manner, until further notice.
  • Recovery Auditors shall complete all Discussion Periods that are underway as of June 1, 2014.
  • Recovery Auditors shall continue to accept new Discussion Period requests until June 30, 2014. All Discussion Periods initiated during June shall be completed. 
  • Recovery Auditors shall not accept new Discussion Period requests on or after July 1, 2014.
  • Recovery Auditors shall continue to maintain their customer service areas (telephone lines and appropriately training staff) and process for escalating concerns, until further notice.
  • Recovery Auditors shall continue to support the appeal process.
Note: Medicare Administrative Contractor (MAC) processes will continue. Therefore, claims sent for adjustment, by a Recovery Auditor, on or before June 1, 2014 may complete the adjustment process on, or after, June 2, 2014. The Medicare Appeals process will also continue. Therefore, recoupments can occur, if a provider does not file a timely appeal (to the 1st or 2nd level of appeal), or receives an “unfavorable” decision at the 2nd level (QIC) of the appeals process.

For more information regarding the RAC contractor procurement status and Part B therapy Manual Medical Review (MMR) process see our prior blog on the issue.

Please contact AHCA's Dan Ciolek if you have questions.  

No comments:

Post a Comment