CMS announces tentative new date for recovery audit prepayment reviews

The Centers for Medicare & Medicaid Services (CMS) anti-fraud programs that had an original start date of January 1, 2012, will now be implemented "on or after June 1," according to a recent announcement.

The programs, which will include recovery audit prepayment reviews, will allow recovery audit contractors (RACs) to review historically improper claims before payment. Ensuring compliance with Medicare rules prior to payment will help avoid the traditional pay-and-chase method, which involves Medicare making efforts to recoup improper payouts that have already been made.

Once the programs are launched, RACs will target seven states with high populations of providers prone to fraud and error (California, Florida, Illinois, Louisiana, Michigan, New York and Texas), as well as four states with high short inpatient hospital stay claims volumes (Missouri, North Carolina, Ohio and Pennsylvania).

According to a December CMS announcement, the decision to postpone the launch was made in order to allow the agency to consider comments and suggestions received in the wake of an announcement about the programs that was made the month before. 

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