CMS considers extra incentive for auditors

Tuesday, January 31, 2006

BALTIMORE - CMS may offer financial incentives to auditors who discover underpayments to providers. Currently, the Recovery Audit Contractors receive only a percentage of recovered overpayments.
CMS discussed expanding the incentives at a special Open Door Forum recently. The forum addressed the agency's Recovery Audit Contractors: 3 Year Demonstration Project.
The demo, mandated by the Medicare Modernization Act, requires the use of contractors to identify Medicare underpayments and overpayments. The project began in March 2005 and runs through March 2008. CMS began visiting in late 2005 the three demo states--California, New York and Florida--to make sure providers understand the project.
In November, CMS started sending providers demand letters and medical record requests as part of the demo.
"Our goal is to not be obtrusive to the business of providers," a CMS official said during the Nov. 18 Open Door Forum. "We need to do this demo as required by Congress, and we will do it in a very collegial way. That is our goal."
CMS officials stressed that all other Medicare rules regarding the opening of a claim must be followed.