The Recovery Audit Program and Medicare

1 The Recovery Audit Program and Medicare The Who, What, When, Where, How and Why? 2 Agenda What Is A Recovery Auditor? Will The Recovery Auditors Affect Me? Why Recovery Auditors? What Does A Recovery Auditor Do? What Are The Providers Options? What Can Providers Do To Get Ready? 3 What Is A Recovery Auditor? The Recovery Auditors Program Mission The Recovery Auditor detect and correct past improper payments so that CMS can implement actions that will prevent future improper payments: o Providers can avoid submitting claims that do not comply with Medicare rules o CMS can lower its error rate o Taxpayers and future Medicare beneficiaries are protected. 4 Will The Recovery Auditors Affect Me? Yes, if you bill fee-for-service programs , your claims will be subject to review by the Recovery Auditors. 5 Why Recovery Auditors? Recovery Audit Legislation: Medicare Modernization Act, Section 306 Required the three year Recovery Audit demonstration Tax Relief and Healthcare Act of 2006, Section 302 Requires a permanent and nationwide Recovery Audit Program by no later than 2010 Both Statutes gave the CMS the authority to pay the Recovery Audits on a contingency fee basis.

o Remark Code N432: Adjustment Based on Recovery Audit Carrier/FI/MAC recoups by offset unless provider has submitted a check or a valid appeal. 8 What Is Different? Recovery Auditors will offer an opportunity for the provider to discuss the improper payment

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