CMS Announces "Pause" in RAC Audits

Explore:  Audits CMS Healthcare RACs

On Tuesday, 2/18/14, Centers for Medicare & Medicaid Services (CMS) announced on its website that it is “pausing” the Recovery Audit Program (RA Program) in preparation for the procurement of new Recovery Audit (RA) contracts and to “allow CMS to continue to refine and improve the Medicare Recovery Audit Program.”  To obtain a complete copy of the announcement go to CMS' website

Specifically, CMS states in the announcement that it is in the procurement process for the next round of RA Program contracts.  According to CMS, it is important that the agency transition down the current contracts so that Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts.  In addition, a pause in operations will allow CMS to continue to refine and improve the RA Program.   Several years ago, CMS stated it made substantial changes to improve the RA program, and will continue to review and refine the process as necessary.  Providers should note the important dates below:

  • February 21 is the last day an RA may send a postpayment Additional Documentation Request (ADR)
  • February 28 is the last day a MAC may send prepayment ADRs for the RA Prepayment Review Demonstration
  • June 1 is the last day an RA may send improper payment files to the MACs for adjustment

Any questions from providers should be directed to this email.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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