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Written by: Darlene D'Altorio-Jones (1959-2015) on Friday, October 11, 2013 Posted in: Inpatient Rehab

‘Transitions’ are not just the name of special lenses for your eyeglasses. They are also in the Recovery Audit Contractor world. Transition is the period we are seeing right now, when from time to time CMS ‘transitions’ services from one audit contractor to another. If you don’t feel like your workload has slowed down, it’s likely due to the fact that the outgoing auditors made a full blown push to pick up as many approved review conditions as possible in their final hurrah for payment performance. They also wanted to keep work in their pipeline before the stoppage was invoked and new awards were announced.

CMS describes the transition period like this: “From time to time in the Recovery Audit Program, transitions from one Recovery Auditor to another Recovery Auditor will need to occur (e.g., when the outgoing demonstration Recovery Auditors cease work and the new incoming permanent Recovery Auditors begin work).” CMS applies a ‘work slow down’ in order to review new contracts, halt any new reviews by outgoing contractors and prepare a more smooth transition from one to another, even if the SAME contractor could be awarded a future contract this same process is exercised prior to announcing the newest awardees and regions. CMS states, “The impact may vary from little to no impact to a work stoppage in a particular area for a 3-6 month period of time (or more dependent on the transition). The impact to the recovery audit program will be determined within 60 days of the announcement of the upcoming transition.

Each impacted Recovery Auditor will be required to submit a transition plan to CMS for approval. The lack of an approved transition plan will result in a minimum transition time of 6 months.” So what does that look like right now and what is changing?

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CMS announced on May 22, 2013, that they had begun the procurement process for the new Medicare Fee for Service Recovery Audit Program contracts. A Request for Quote (RFQ) was issued through the General Services Administration. CMS plans to contract with four A/B Recovery Auditors and one national DME and Home Health/Hospice Recovery Auditor. The density has been redistributed to enable a more even workload among contractors. Previous Jurisdictions:

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Although we are not provided the names just yet, that information will be soon be forthcoming as a six month leadway takes us to mid-November. As soon as that information becomes available we’ll link you to the source and any updates provided through the CMS RAC website page. For now, just find yourself on the map and learn if you are Region 1, 2, 3 or 4.

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