Tuesday, November 22, 2016

CMS Finalizes New RA Program Contracts

Dianne De La Mare


The US Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has awarded 5 new contracts for Medicare's Recovery Auditor (RA) program to Performant Recovery, Cotiviti and HMS Federal Solutions. Performant Recovery and Cotiviti both have 2 contracts, and will operate in two different regions. Past RA contractor, CGI Group, will not return and opted out of the most recent RA procurements. 

The new contracts update how RAs are paid, audit timelines and the current review process. Medicare RAs will now only receive payment after a provider’s challenge has passed the 2nd level of a 5-level appeals process; and RAs must follow new audit timelines. 

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