March 4, 2014
Immediate Suspension of Edits for Recovery Audit Prepayment Reviews, Including Outpatient Therapy
Effective February 28, 2014, there are two important changes regarding Recovery Audit Prepayment Reviews, including reviews for outpatient therapy. CGS, and other Medicare Administrative Contractors (MACs), will:
- No longer issue Additional Documentation Requests (ADRs) related to Recovery Audit Prepayment Reviews, including outpatient therapy, and
- Suspend ALL edits related to Recovery Audit Prepayment Reviews, including outpatient therapy.
These changes are being made based on the current Recovery Audit procurement process. It is vital that the Centers for Medicare & Medicaid Services (CMS) ensure the smooth transition of workload in order to guarantee minimal disruption to the provider community. The last day that Recovery Auditors will send ADRs and Semi-Automated Notification Letters to providers is February 21, 2014.
CGS will process therapy claims in accordance with established guidelines.
For further information, refer to the following resources:
- CMS MLN Matters article MM8407, "Therapy Cap Values for Calendar Year (CY) 2014"
- CMS Therapy Services Web page