On December 29, 2011, CMS announced it is indefinitely delaying implementation of its controversial Recovery Audit Prepayment Review demonstration and the separate Prepayment Review and Prior Authorization for Power Mobility Devices demonstration, both of which were scheduled to begin on January 1, 2012. While CMS has not provided a new target implementation date, CMS states that it will provide at least 30 days notice before the demonstrations begin. A third demonstration, CMS’s Part A to Part B rebilling demonstration, began as scheduled on January 1, 2012. The delay announcement follows a December 21, 2011 CMS provider call on the Recovery Audit Prepayment Review demonstration, under which CMS plans to expand the use of Medicare Recovery Auditors in the Medicare fee-for-service program to review claims before they are paid. On this call, CMS announced that the MS-DRGs scheduled to be included in the project are:

  • 1/1/2012: MS-DRG 312 Syncope & Collapse
  • 3/1/2012: MS-DRG 069 Transient Ischemia, MS-DRG 377 GI Hemorrhage W MCC
  • 5/1/2012: MS-DRG 378 GI Hemorrhage W CC, MS-DRG 379 GI Hemorrhage W/O CC/MCC
  • 7/1/2012: MS-DRG 637 Diabetes W MCC, MS-DRG 638 Diabetes W CC, and MS-DRG 639 Diabetes W/O CC/MCC.

It is unclear whether CMS will continue to focus on these DRGs when it proceeds with implementation of the demonstration, or what other changes may be made in the program.