Medicare Recovery Audit Program Update

After learning last week at the Administrative Law Judge (ALJ) Forum that a significant increase in the number of audits in the Recovery Audit (RA) program over the last several years is a major factor in the two plus year backup at the ALJ level, the Centers for Medicare and Medicaid Services (CMS) announced on its website that it is “pausing” RA audits in preparation for the procurement of new RA contracts and to “allow CMS to continue to refine and improve the Medicare RA Program.”  To obtain a complete copy of the announcement click here.

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 the RAs 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 states that it made substantial changes to improve the RA program, and it will continue to review and refine the process as necessary.  Providers should note the important dates below:

  • February 21 is the last day a 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 a RA may send improper payment files to the MACs for adjustment

Any questions from providers should be directed to