Recent Updates

10/22/12 - Change in Recovery Auditor for Some Providers

If a provider is located in any state other than Missouri, Kansas, Iowa or Nebraska (i.e. Jurisdiction 5 for Wisconsin Physician Services (WPS), and WPS is their Medicare Administrative Contractor (MAC), there has been a change in their Recovery Auditor.  As of 10/22/12 the Recovery Auditor for these providers is HealthData Insights.

This change occurred because the Centers for Medicare & Medicaid Services (CMS) completed a contracting transition involving the MAC. This transition did not impact the provider’s MAC but the transition required the change in the Recovery Auditor.  

All impacted providers will be notified by HealthData Insights via postal mail.

All open additional documentation requests and any requests where a demand letter has not been generated were canceled and closed. Claims in process and claims data from the other Recovery Auditors will not be shared with HealthData Insights

Note:  This does not impact providers in Jurisdiction 8 where WPS is also the Medicare Administrative Contractor.  The change in Recovery Auditor is only specific to those providers who originally had WPS pay their claims as the national fiscal intermediary.

August 16, 2012 - The Prepayment Review Demonstration now has its own Web page and shortened URL as follows: http://go.cms.gov/racprepay

March 26, 2012- Beginning April 1, 2012, CMS will begin instituting a reimbursement cap of $25 per medical record.  Any medical record submitted to a Recovery Auditor after April 1, 2012 will receive a maximum of $25 per medical record.  This includes both the $0.12 per-page cost for photocopying, as well as first class postage.    

Do you have questions or comments about the Recovery Audit Program? Please e-mail us at: RAC@cms.hhs.gov. Please Do Not send Personal Health Information to this e-mail address. Thank you.