The Centers for Medicare & Medicaid Service’s (CMS) is transitioning to new recovery audit program contracts, which will temporarily change pre- and post-payment manual medical review processes for therapy services over $3,700. In addition, the transition may also create delays in the typical 10-day review cycle, according to a news release from the American Physical Therapy Association (APTA). CMS is securing the next round of recovery audit program contracts and is planning a “pause in operations” while new contracts are started.
The APTA news release notes that the pause in operations will have different ramifications depending on whether a specific state is subject to pre- or post-payment review of therapy services exceeding $3,700. In post-payment states, February 21 was the last day that Additional Documentation Request Letters (ADR) for post-payment review were sent to providers, while February 28 is the last day that Medicare administrative contractors will send out letters for prepayment reviews of therapy claims until new contracts are awarded in prepayment states.
The APTA news release indicates that after February 28, prepayment reviews will not be conducted; claims, instead, will undergo post-payment review after the new contracts are in place. Due to the volume of claims CMS expects will accumulate during this transition, the 10-day reviewing time frame will not apply to these reviews. The new recovery auditors will review claims in the order that they were paid.
If a provider has received an ADR letter, the provider must comply with the request and submit the records, as indicated on the APTA news release. Any records previously submitted to the recovery auditor will continue to be reviewed, and the provider will receive a review results letter, which is standard. Providers can monitor progress of the transition at the CMS website: www.cms.gov.