North Carolina was chosen for inclusion in the demonstration because CMS has identified it as having a high number of inpatient stays – not because North Carolina has been identified as an error-prone state.
Recovery auditors will begin by reviewing claims prior to payment to ensure that healthcare professionals have followed all Medicare rules. Initially, reviewers will focus on short stay inpatient hospital claims. CMS has stated that the goal of this program is to avoid improper billing before payment occurs, rather than audit on a “pay and chase” basis.
This week CMS held an Open Door Forum to discuss the demonstration and answer provider questions, including a list of the targeted MS-DRGs. Slides from this call are available here and a full transcript of the call will be available no later than August 16.