News: Prepayment reviews demonstration project set to begin in August

On August 27, CMS launches its Recovery Audit Prepayment Review demonstration project. Over the next three years, the agency will contract with auditors to review medical records prior to payment.

 

Originally announced in November 2011, the project was delayed from its planned January 2012 start.

The demonstration begins in what CMS deems as high fraud, high error-prone states, including Florida, California, Michigan, Texas, New York, Louisiana, and Illinois, as well as four states with high claim volumes of short inpatient hospital stays—Pennsylvania, Ohio, North Carolina, and Montana.

 

“The demonstration will help lower the error rate by preventing improper payments rather than the traditional ‘pay and chase’ methods of looking for improper payments after they occur,” CMS says in a release.