Health Law Blog

CMS Announces RAC Audits To Begin in New York State

The Centers for Medicare and Medicaid Services (CMS) announced that Performant Recovery, Inc., New York’s Medicare Fee-for-Service Recovery Audit Contractor (RAC) for Region 1, can begin recovery audit activity now that provider outreach is complete. Region 1 includes the following groups of states:  J8, WPS: Michigan and Indiana; J15, CGS: Ohio and Kentucky; JK, NGS: New York, Vermont, Massachusetts, Rhode Island, Maine, New Hampshire, and Connecticut.

Performant will perform post-payment reviews to identify and correct Medicare claims that contain improper overpayments and underpayments that were made under Medicare Parts A and B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice. According to an estimate released on September 30, 2015, the group of states containing New York makes up approximately 12% of the national Part A and B workload. These reviews will not consider short-stay “patient status” reviews—unless the hospital is identified by Livanta, New York’s Quality Improvement Organization, for an additional audit.

Per CMS, the awards of these contracts seek to continue the implementation of many of the Recovery Audit Program enhancements designed to reduce provider burden, enhance program oversight, and increase transparency in the program.

For more information concerning RAC audits, please contact David R. Ross, Esq. or Mary T. Connolly, Esq.

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