Regulations

RAC audits put on hold by CMS

In a recent announcement, CMS stated that is in the procurement process for the next round of Recovery Audit Program contracts. CMS will transition down the current contracts so that the Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts. CMS said that a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program.

The announcement says:

Several years ago, CMS made substantial changes to improve the Medicare Recovery Audit program. CMS will continue to review and refine the process as necessary. For example, CMS is reviewing the Additional Documentation Request (ADR) limits, timeframes for review and communications between Recovery Auditors and providers. CMS has proven it is committed to constantly improving the program and listening to feedback from providers and other stakeholders.

Providers should note the important dates below:

  • February 21: The last day a Recovery Auditor may send a postpayment Additional Documentation Request (ADR)
  • February 28: The last day a MAC may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration
  • June 1: The last day a Recovery Auditor may send improper payment files to the MACs for adjustment

CMS has asked providers with questions to contact RAC@cms.hhs.gov for more guidance.