Recovery Audit Prepayment Review Demonstration

December 2011

A new three year Recovery Audit Prepayment Review Demonstration will start January 1, 2012.  The demonstration will allow RAC contractors to conduct prepayment claim reviews for medical necessity prior to reimbursing for services rendered, thereby shifting greater risk to providers to ensure the furnished procedure is clinically approprate for the patient’s condition.  The demonstration will be conducted in 11 states: CA, FL, IL, LA, MI, MO, NC, NY, OH, PA and TX.