Skip navigation

David McGill Blogger

A Temporary Reprieve

Posted by David McGill | February 20, 2014

Medicare has announced a "pause in operations" for its Recovery Audit Program. (No, this isn't an early April Fool's joke.) The stated basis for the stay in audits is the need for the current Recovery Auditors to complete all outstanding claim reviews before their current contract terms with CMS run out. 

CMS additionally acknowledges that this "will allow CMS to continue to refine and improve the Medicare Recovery Audit Program," with a particular focus on Additional Documentation Request limits, timeframes for review, and communications between RA's and providers.

CMS will implement the following changes over the next 10 days:

  • RA's cannot send postpayment Additional Documentation Requests to suppliers after this Friday, February 21
  • MACs cannot send prepayment Additional Documentation Requests to suppliers after February 28.
Also, RA's cannot send improper payment files to the MACs after June 1.

What does this mean for you?

In the near term, the dark clouds of RA audits that have hung over the O&P industry (and the entire world of DMEPOS) will part for several months pending CMS's award of new contracts to RA's. The RA's will stop new auditing activity to focus on completing the backlog of cases that they've generated over the last few years.

However, do not throw out your claims raincoats and umbrellas! Based on the announcement, we fully expect the RAC program to crank back up again after CMS awards new contracts. So view this  break as your final reprieve, your chance to get all your claim processes tightened up and perfected before the next wave begins again later this year.

Ossur has several resources available that can help you upgrade your company's performance during the lull in auditing. The Audit Team offers claim reviews to ensure that your claims satisfy Medicare's requirements, and GPM Consulting offers you the opportunity to go through a mock audit of all your core business processes. For more information about either of these services, please email us at [email protected]

Össur R&R

The Source for O&P Reimbursement & Regulatory News & Analysis

If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at [email protected]