CMS delays RAC prepayment audits until June

In response to provider concerns about administrative burdens, the Centers for Medicare & Medicaid Services delayed anti-fraud programs and say they now are expected to "move forward on or after June 1," including Recovery Audit Prepayment reviews.

Originally slated for Jan. 1, the CMS anti-fraud programs are part of a federal crackdown on waste and abuse. Prepayment reviews will allow recovery audit contractors (RAC) to review historically improper claims before payment so that providers comply with Medicare rules. RAC reviews will target seven states with high populations of fraud- and error-prone providers (Florida, California, Michigan, Texas, New York, Louisiana, Illinois) and four states with high claims volumes of short inpatient hospital stays (Pennsylvania, Ohio, North Carolina, Missouri). The goal is to prevent the traditional pay-and-chase method, in which Medicare doles out payment and then looks for improper payments after they occur.

The national initiative will increase the number of claims subject to review from 1.2 million to 2.7 million claims a year, according to American Medical News.

CMS also delayed a program for power mobility devices until June 1. Geared toward ensuring that Medicare beneficiaries' conditions warrant scooters and power wheelchairs, the program will implement a prior authorization process in seven states with high populations of fraud- and error-prone providers (California, Illinois, Michigan, New York, North Carolina, Florida, Texas).

To learn more:
- check out the CMS announcement

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