Future Audit Demand Letters to Come from MACs

In a new Medicare Learning Network (MLN) document, the Centers for Medicare & Medicaid Services (CMS) indicate that starting next year, demand letters related to audits will no longer be issued by Medicare's recovery auditors.

Instead, the MLN document - number MM7436 -- says, the Medicare Administrative Contractors (MACs) will issue the letters starting on Tuesday, Jan. 3, 2012.

As of that date, the MLN document says, "CMS is transferring the responsibility for issuing demand letters to providers from its recovery auditors to its claim processing contractors. This change was made to avoid any delays in demand letter issuance."

Starting next year, when a recovery auditor determines that a supplier has received in incorrect payment, the auditor will submit a claim adjustment to the appropriate MAC. The MAC "will then establish receivables and issue automated demand letters for any recovery auditor-identified overpayment."

CMS noted that the MAC "will follow the same process as is used to recover any other overpayment from you."

The recovery auditor will still be responsible for answering specific audit questions "such as their rationale for identifying the potential improper payment." But the MAC will handle administrative concerns, "such as the timeframe for payment recovery and the appeals process."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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