Medicare-Medicaid Audit World
On July 25, 2012, CMS modified the text of its announcement of the Recovery Audit Pre-payment Review demonstration by changing the start of the demonstration from summer 2012 to August 27, 2012. CMS also announced that it will hold a Special Open Door Forum on an as yet unannounced date in August.
The history of the demonstration
CMS first announced the Pre-payment Review demonstration on November 15, 2011. In a Fact Sheet released that day, CMS stated that the demonstration would begin on January 1, 2012 and last three years. During the demonstration, Recovery Auditors will review provider billing before payment is made for selected claim types chosen by CMS in FL, CA, MI, TX, NY, LA, IL, PA, OH, NC and MO and deny payment if they decide the billing is improper. The initial claim types selected by CMS for review were:
- MS-DRG 069 Transient Ischemia;
- MS-DRG 312 Syncope & Collapse;
- MS-DRG 377 G.I. Hemorrhage W MCC;
- MS-DRG 378 G.I. Hemorrhage W CC;
- MS-DRG 379 G.I. Hemorrhage W/O CC/MCC;
- MS-DRG 637 Diabetes W MCC;
- MS-DRG 638 Diabetes W CC; and
- MS-DRG 639 Diabetes W/O CC/MCC