August 7, 2014

Recovery Auditors to Restart Limited Number of Reviews

The Centers for Medicare & Medicaid Services (CMS) has announced Recovery Auditors will restart a limited number of reviews under the existing contractors until contract issues related to the new awards are resolved. CMS stated that, as part of the rebidding process for the contractors, an unexpected delay occurred when a number of contests from parties bidding for this work were filed and a judge ordered that CMS not finalize the contract selections. CMS is modifying its contracts with the current Recovery Auditors in the Medicare Fee for Service Recovery Audit Program to allow a limited number of new automated reviews as well as a small number of complex reviews on selected claim areas, including spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies and cosmetic procedures. CMS expects the current Recovery Auditors to restart work of these limited new reviews in August 2014. There will be no "inpatient status" reviews during this limited restart period.


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