The CMS has extended its contracts with its current four vendors until Dec. 31, 2015, for “administrative and transition activities.” The contracts were to end on Feb. 7.
The purpose of the extension is to allow the current contractors to handle and wind down appeals.
For providers, that means a lull in additional documentation requests, or ADRs, while the CMS addresses both a backlog of claims and concerns about the effectiveness and fairness of the program.
“It obviously puts on hiatus a pretty enormous administrative burden,” Evans said. “However, this period of time—while they're not getting any (ADRs)—could still be audited in the future. No one should let down their guard.”
The program currently has a three-year look-back period.
Tomorrow, however, is the last day a recovery auditor can send a post-payment ADR, and Feb. 28 is the last day Medicare administrative contractors can send a pre-payment ADR to the Recovery Audit Prepayment Review Demonstration. June 1 is the last day for auditors to send improper payment files to Medicare administrative contractors for adjustment.
The appeals process has become so overloaded that HHS' Office of Medicare Hearings and Appeals recently began notifying hospitals that it won't be able to accept new appeals until the backlog clears.
Sixty-five administrative law judges are now receiving 15,000 claims per week, when they're only equipped to handle 2,000. That has meant a collective backlog topping 350,000 appeals.
While providers may enjoy some breathing room, a group that represents the program's contractors called the move “very disappointing” and “another hurdle for the highly effective RAC program.”
“This decision will undoubtedly have negative implications for the Medicare trust fund and, most importantly, taxpayers,” said a spokeswoman for the American Coalition for Healthcare Claims Integrity in a statement, pointing out that Medicare lost $36 billion to waste last year. “The ongoing efforts by hospitals to eliminate Medicare oversight, and the complicity of Congress, is deeply concerning.”
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