CMS Recovery Audit Prepayment Reviews Slated to Begin Summer 2012

Friday, June 08, 2012

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Centers for Medicare & Medicaid Services (CMS) is planning to move forward with the Recovery Audit Prepayment Review (RAPR) Demonstration Project on [stat.] June 1, 2012. It was originally scheduled to begin January 1, 2012.

Recovery Audit Contractors (RACs) will Review Claims with High Rates of Improper Billing.

The Recovery Audit Prepayment Review allows Recovery Audit Contractors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that have been found to result in high rates of improper payments.

Seven States will be the Focus of the Initial Launch of Recovery Audit Prepayment Reviews.

The Recovery Audit Prepayment Reviews will focus on seven states with high populations of fraud-prone and error-prone providers. These states are California, Florida, Illinois, Louisiana, Michigan, New York, and Texas. The Recovery Audit Prepayment Reviews will also include four states with high claims volumes of short inpatient hospital stays. These states are Missouri, North Carolina, Ohio, and Pennsylvania.

More States May be Included in the Recovery Audit Prepayment Review Demonstration in the Future.

CMS is expecting that the prepayment reviews will help lower error rates by preventing improper payments instead of searching for improper payments after they occur. If these reviews are successful, other states will be included in subsequent roll-outs of the Recovery Audit Prepayment Review Demonstration.

Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.

The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Reimbursement Management Consultants, Inc. "CMS Recovery Audit Prepayment Review Demonstration Project." Reimbursement Management Consultants, Inc. (Feb. 9, 2012). From:
http://rmcinc.org/word/?p=276

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Tag words: Medicare fraud, medicare, false billing, overpayment, Recovery Audit Contractor, RAC, Medicare audit, Medicare investigation, health care fraud, Medicare fraud attorney, Recovery Audit Prepayment Review, RAPR, Centers for Medicare & Medicaid Services, CMS, prepayment audit, prepayment review, overbilling, audit defense attorney, legal defense lawyer

6/8/2012

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