Recovery Audit Program Recent Updates

July 22, 2015
Rick Gawenda

Effective June 4, 2015, The Centers for Medicare and Medicaid Services (CMS) has withdrawn the Requests for Quotes for the next round of Recovery Auditor contracts. CMS plans to update the Statement of Work and release new Requests for Proposals shortly. In the meantime, the current Recovery Auditors will continue active recovery auditing through at least December 31, 2015.

In addition, in mid-January 2015, CMS approved the Recovery Auditors to begin reviewing Outpatient Therapy Threshold claims (those over the $3700 threshold) that were paid March 1, 2014 through December 31, 2014. In an effort to minimize provider burden, CMS set restrictions on the number of Additional Documentation Requests (ADRs) that could be sent related to these claims, as shown below.

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  1. I am the owner of a outpatient private practice clinic in Kingsville Texas. With regards to ADRs and Recovery Audits,does CMS only perform ADRs on those claims that are over the cap? or any claim for any patient ?
    I was recently asked by a previous employer to sign and verify a exercise flow sheet for exercises that I did not actually supervise…as times were changed to match a flow sheet the owner had made up to match his billing.I declined to assist in this false practice and did not agree to any of his requests to assist in a medicare audit. The patient claims were over 3 years old and I did not recognize any of the patients and am fairly certain that some of the dates were provided while i was on vacation. My question is this…although my former employer requested I sign a false exercise sheet, I am not obligated to assist in his recovery audit correct? and if the the audit was to recoup money from an audit would that also mean the ir was a 2-4th ADR?

    1. I would recommend you contact your attorney and state PT board as you may be obligated to report what you know to your State Board.