News: CMS discusses new Recovery Auditor scope of work

CMS recently updated its Recovery Audit program webpages with names of each new contractor, respective regions of responsibility, with links for updates, program reports, provider resources, and historical programs, according to Valerie A. Rinkle, MPA, a lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp®, who listed to CMS’ Open Door Forum Call on the matter, and wrote about the subject for the Revenue Cycle Insider.

RA focus areas have yet to be released, but as with the previous contracts, CMS will approve all RA targets and post information on its website as well as on the RA portals. Inpatient medical necessity reviews, “one of the most significant and contentious audit topics under the first RAC” aren’t included in the current contracts, Rinkle says. Instead, contractors will conduct automated and complex audits and are encouraged to focus on issues identified by Comprehensive Error Rate Testing (CERT) reviews, according to the contract scope of work.

CERT targets are far from government secrets. Medicare publishes a Quarter Compliance Newsletter, which explored documentation and coding compliance concerns related to facet joint injections, radiation therapy, transluminal balloon angioplasty for hemodialysis fistulas, endovenous ablation therapy of incompetent vein, transurethral resection of the prostate (TURP), among others.

Once audits begin, audit findings may be communicated to providers either via a letter or an online portal each of the RAs will be required to maintain.