CMS selects recovery audit contractors for Medicare claims
In 2014, recovery auditors identified $2.39 billion in overpayments and $173.1 million in underpayments repaid to providers.
The Centers for Medicare and Medicaid Services has announced the contractors awarded the next round of Medicare fee-for-service recovery audit contracts.
They are Performant Recover in Regions 1 and 5; Cotiviti in Regions 2 and 3; and HMS Federal Solutions in Region 4.
The contractors awarded the first four regions will perform post-payment review to identify and correct Medicare Part A and B claims that contain improper payments, CMS said on Monday. This is for overpayments or underpayments for all provider types other than durable medical equipment, prosthetics, orthotics, and supplies and home health/hospice.
The region 5 contractor will be dedicated to the post-payment review of DMEPOS and home health/hospice claims nationally.
[Also: Medicare audits not able to keep up with backlog of appeals, GAO says]
Odd contractor out is CGI Federal. Two years ago CGI protested when CMS changed its payment terms to contractors, and in 2015, won its case in Federal Circuit Court to challenge CMS, according to Law360.
The Medicare fee for service recovery audit program identifies and corrects overpayments made on Medicare claims and identifies underpayments to providers for correction.
In demonstrations held between 2005 and 2008, recovery auditors were found to be a successful tool in the identification and prevention of improper Medicare payments, CMS said.
In 2014, recovery auditors identified $2.39 billion in overpayments and $173.1 million in underpayments repaid to providers. After taking into consideration the costs of the program, the audit program returned over $1.6 billion to the Medicare Trust Funds, the report said.
[Also: CMS hits Humana with $3.1 million penalty for violations found in audit]
The recovery audit program is designed to reduce provider burden, enhance program oversight, and increase transparency in the program, CMS said. However, providers have reportedly complained of payment delays due to a backlog of appeals.
To smooth the transition between contractors, CMS said October 1 was the last day a recovery auditor could send claim adjustment files, though providers may still receive some correspondence related to the current audit.
However, at no time will providers have to respond to auditors more frequently than every 45 days, or from two different recovery auditors, CMS said.
Twitter: @SusanJMorse
