Monthly Minute Blog

New York State Participating in the Recovery Audit Prepayment Review Demonstration

Thursday, 21st July, 2016 12:00 am | by

New York State Participating in the 
Recovery Audit Prepayment Review Demonstration
 
CMS issued final guidance on manual medical reviews for Medicare outpatient therapy claims above $3,700.  New York State has been identified as one of 11 states participating in the Recovery Audit Prepayment Review Demonstration, meaning 

 1. All claims will continue to go to the MACs, but the MAC will send an Additional Documentation Request to the provider requesting the additional documentation be sent to the Recovery Auditor.

 2.The Recovery Auditor will conduct prepayment review within 10 business days of receiving the additional documentation and will notify the MAC of the payment decision. 

Click here to see the Frequently Asked Questions recently posted by CMS

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