CMS: Audits, authorizations must be added to data warehouse

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Thursday, September 11, 2014

WASHINGTON – Contractors conducting pre-pay audits and prior authorizations are required to load that information into the RAC Data Warehouse, CMS has said in response to an AAHomecare inquiry. “Contractors conducting pre-pay audits are required to load that information into the RAC Data warehouse,” CMS said. “Claims that are paid through one of the prior authorization programs have a unique tracking number that follows the claim and is included in all data shared with the Recovery Auditors. Claims with a unique tracking number are excluded from Recovery Auditor review.” AAHomecare said in a bulletin that it was pleased with CMS’s statement and plans to work with DME MACs provider outreach and education groups to ensure such processes are in place.