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Association Welcomes CMS Announcement of Recovery Audit “Pause”  
Association Welcomes CMS Announcement of Recovery Audit “Pause”
Stakeholders seek solutions to vexing number of backlogged claims, says Parkinson
Contact: AHCAPressOffice@ahca.org
(202) 898-3165
FOR IMMEDIATE RELEASE

2/20/2014

Washington, D.C. – Today, the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) released a statement upon the Centers for Medicare and Medicaid Services’ (CMS) announcement to “pause” the Recovery Audit (RA) program while it continues “to refine and improve the Medicare Recovery Audit Program” and reviews the best services and costs for the next round of RA contracts.  AHCA/NCAL and other provider and consumer groups have been persistent in objecting to the current long delays in the resolution of Medicare audit appeals for providers. In many cases, the appeals process has ballooned to over a two-year wait for adjudication.

The following is a statement from AHCA/NCAL President and CEO Mark Parkinson:

“Today, we recognize the positive move by CMS to temporarily suspend the Recovery Audit (RA) process, which is a major reason for the clogged appeals pipeline at Level 3 of the five-level Medicare appeals process. Even though this action is primarily related to future contracts, CMS noted in the announcement that it ‘is committed to constantly improving the program and listening to feedback from providers and other stakeholders.’

“This ‘RA pause’ is a welcomed next step in the long term and post-acute care community’s goal of timely and appropriate initial Medicare claim processing and early appeal decisions. There needs to be fewer inaccurate Medicare contractor audits, and claims appeals need to flow on a faster timetable in order for the process to work for all parties: providers, regulators and the recipients of the care we provide.”

Last week AHCA/NCAL applauded the Office of Medicare Hearings and Appeals (OMHA) for its initiative in hosting the stakeholder forum on the impact of the Administrative Law Judge (ALJ) backlog situation.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 12,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and developmental disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit www.ahca.org or www.ncal.org.


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