The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
Quick Response to Recovery Auditor Prepayment Demonstration Requests Recommended
The Recovery Auditor Prepayment Demonstration Program is intended to prevent improper payments before they are made. CMS announced recently that providers will have 30 days to respond to additional document requests related to the program. A failure to respond within this time will result in claim denials. A spokesperson for CMS said that Recovery Auditor Contractors will review documentation and will send a determination within 45 days. The demonstration program will be run in the following seven states that are Medicare fraud and error prone: Florida, California, Michigan, Texas, New York, Louisiana, and Illinois. In addition, audits will be performed in states with a high volume of inpatient stays including Pennsylvania, Ohio, North Carolina and Missouri. Additional information is available at www.go.cms.gov/cert-demos.