Recovery Auditor

Recovery Auditors identify improper Medicare payments made on healthcare claims. These audits may result in the identification of Medicare overpayments and/or underpayments. Providers that may be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Part A and Part B.

RAs identify specific issues to pursue but are limited to claims approved through the CMS "new issue review" process. In some cases, a small number of "non-posted issue" requests may be requested from providers as the Recovery Auditor requests sample data to supply to CMS on an issue the RA would like approved. Prior to a widespread review, all approved issues are posted on the Recovery Auditor's website. Noridian urges providers to stay informed of the new issues that are identified by the RA contractor.

Contact - HDI, HMS, CMS and Noridian - View contact information including website, address and email.

Types of Reviews - View the three types of Recovery Auditor reviews and the action providers should take.

Recovery Auditor Demand Letters Issued by Medicare Contractors - View information about how to respond to Demand Letters.

Recovery Auditor Determinations - Agree or Disagree - Agree or disagree with the Recovery Auditor determination? Check out your options.

Recovery Auditor - Discussion Period Process This link takes you to an external website. – View HMS' discussion period process and forms required to submit a discussion period request.

NOTE: The Noridian Provider Contact Center is only able to answer general questions about the Recovery Auditor program. Providers are advised to contact the Recovery Auditor directly with inquires related to their activities.

Resources

Last Updated May 25, 2017

View the Region 4 Recovery Auditor Website