After months in pause mode due to backlogs in the appeals process, the Centers for Medicare & Medicaid Services (CMS) has reinstated the recovery audit process.
Recovery auditor contractors (RACs) were cleared to restart reviews in all regions under RAC contract modifications issued by CMS last week, ending a nearly six-month stoppage on most reviews.
Most of the reinstated reviews will be conducted through automated processes, but CMS has identified several topics that can trigger complex reviews, including situations where treatment or equipment may not have been medically necessary and where a physician’s judgement on level of needed treatment may be in question.
The recovery audit program, first demonstrated in 2005, uses contractors to discover Medicare/Medicaid billings that result in underpayment or overpayment, resulting in millions of dollars in inaccurate claims being returned to the Medicare Trust Fund.
For more information, visit the CMS Recovery Audit website.