Medicare’s recovery audit reviews expected to start this summer

The Centers for Medicare & Medicaid Services (CMS) has announced that the implementation of its recovery audit prepayment reviews is expected to begin taking place this summer.

According to Fierce Healthcare, the scheduled date for the start of the reviews was January 1 of this year, after CMS announced the policy in November 2011. But due to pushbacks by providers, it was then pushed back to June 1. The organization is now saying that it will begin at some point this summer.

The program was developed by CMS to prevent fraud, abuse and waste within the system, and the organization hopes to protect current patients by improving the efficiency and efficacy of current practices. With the Recovery Audit Prepayment Review, Medicare Recovery Auditors will be allowed review claims before they are paid out to determine that the provider followed CMS' rules and regulations. The reviews will mainly be conducted in states that have a higher number of Medicare discrepancies, including Texas, California and New York. Officials are hoping that the new reviews will help to prevent underpayments as well as duplicate payments.

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