CMS delays Medicare RAC prepayment reviews

After receiving many comments about Medicare prepayment audits scheduled to start this month, the Centers for Medicare & Medicaid Services (CMS) decided to delay the reviews until further notice.

The agency said it will provide at least 30 days notice before implementing the prepayment audits throughout 11 high-fraud states: Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina and Montana.

Until then, Medicare recovery audit contractors (RAC) will continue their "pay-and-chase" method of conducting reviews after issuing hospital payments.

Meanwhile, CMS also will postpone implementing a prior authorization process for scooters and power wheelchairs for Medicare beneficiaries who reside in states with high levels of fraud- and error-prone providers (California, Illinois, Michigan, New York, North Carolina, Florida and Texas), according to the agency's website.

The delayed demonstration projects are part of the government's ramped up anti-fraud efforts to reduce error rates and eliminate Medicare and Medicaid waste and fraud.

To learn more:
- read the CMS notice