CMS delays prepayment review demo
Agency pushes back start date amid provider backlash
Topics: Medicare, Reimbursement, Finance, RAC and Other Post-Payment Audits, Revenue Cycle, Billing and Collections, Cardiovascular, Service Lines, Orthopedics
January 04, 2012
CMS will postpone its Recovery Audit Prepayment Review demonstration project after receiving numerous critical comments about the program.
The three-year project—which was announced in November—would pre-screen certain hospital payments to catch wasteful spending. The program was expected to be implemented in seven states with high populations of fraud- and error-prone providers (California, Florida, Illinois, Louisiana, Michigan, New York, and Texas), as well as four states with high claims volumes of short inpatient hospital stays (Missouri, North Carolina, Ohio, and Pennsylvania).
According to CMS officials, the RAC expansion would revise the current "pay-and-chase" model and lower Medicare's error rate by preventing improper payments. However, in a notice on its website, the agency said it received many comments and suggestions regarding the project and would delay implementation while it considers them.
CMS said it would provide at least 30 days notice before re-launching the delayed project (Daly, Modern Healthcare, 12/30/11 [subscription required]).
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