Medicare pre-payment audits

Medicare pre-payment audits

Jim DeWees

8/16/2012

This is a copy of an article in the O&P Edge which answers a lot of the questions regarding the pre-payment audits. August 2, 2012Medicare RAC Reviews to Begin in AugustContent provided by The O&P EDGECurrent Issue - Free Subscription - Free eNewsletter - AdvertiseThe Centers for Medicare & Medicaid Services (CMS) has announced that the Recovery Audit Prepayment Review demonstration will begin on August 27.The program was originally slated to begin January 1, 2012, but the start date was delayed several times.According to CMS, the Recovery Audit Prepayment Review will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules, which will help prevent improper payments rather than collecting them after they occur. The RACs will conduct prepayment reviews on certain types of claims that have historically resulted in high rates of improper payments. These reviews will focus on seven states CMS has identified as having high populations of fraud- and error-prone providers, California, Florida, Illinois, Louisiana, Michigan, New York, and Texas; and four states with high claims volumes of short inpatient hospital stays, North Carolina, Ohio, Missouri, and Pennsylvania.CMS announced that it will hold an open door forum on the Recovery Audit Prepayment Review Demonstration on August 9, from 2–4 p.m. ET. To participate, call 866.501.5502 and reference Conference ID 16834984. Participation instructions and slides will be posted on the CMS website.