CHA News Article

CMS Announces Changes to Recovery Audit Program

The Centers for Medicare & Medicaid Services (CMS) last week announced important changes to the recovery audit program. Effective Jan. 1, the additional documentation request (ADR) limits for the recovery audit contractors (RACs) will be reduced to one-half of one percent of the hospital’s total number of paid Medicare claims from the previous year. In addition, CMS is establishing future ADR limits based on a provider’s compliance with Medicare rules. Providers with low denial rates will have lower ADR limits, while providers with high denial rates will have higher ADR limits. CMS also released a summary of the past and future scheduled enhancements to the recovery audit program, including reducing the look-back period for patient status reviews to 6 months and requiring RACs to maintain an overturn rate of less than 10 percent at the first level of appeal.