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Practice Management Alert

Payer Updates:

Check to See If CMS Will Be Implementing Pre-Pay Audits in Your State

Published on Sun Aug 19, 2012

Plus, BCBS Rhode Island revamps contracts to focus on quality measures. Prepare yourself: Starting August 27, 2012 CMS will begin its Recovery Audit Prepayment Review prepayment audits in 11 states, according to an announcement on the agency's Web site. This program "... will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules," according to CMS. "The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional [...]
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