Prepayment Review Demonstration

December 13, 2013 - Please find the newly added document "Recovery Audit Prepayment Review Demonstration Status Update 09/26/2013" under the December 13, 2013 Prepayment Review Status Update link in the Downloads section of this page.

This demonstration allows Medicare Recovery Auditors (a.k.a. RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The Recovery Auditors are conducting prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional "pay and chase" methods of looking for improper payments after they occur. This demonstration began on September 1, 2012.  

Do you have questions or comments about the Recovery Audit Program? Please e-mail us at: RAC@cms.hhs.gov. Please Do Not send Personal Health Information to this e-mail address.