What Are the Recovery Auditors' Responsibilities?

Recovery Auditors review claims on a postpayment basis using the same Medicare policies as MACs:

• NCDs
• LCDs and
• CMS manuals/regulations

To ensure accuracy, Recovery Auditors are required to employ nurses, therapists, certified coders and a contractor medical director.

Recovery Auditors use two review processes:

• Automated (no medical record needed)
• Complex (medical record required)

To minimize provider burden, Recovery Auditors may look back only three years from the date the claim was paid; however, Recovery Auditors are unable to review claims paid prior to 10/1/2007.

Reviewed 4/29/2024