TAILIEUCHUNG - Statement of Work for the Recovery Audit Program

The results of the audit for fiscal year 2010 provided valuable lessons on preparing for a first-time financial statement audit. In our September 2011 report, we identified five fundamental lessons that are critical to success. 27 Specifically, the Marine Corps’ experience demonstrated that prior to asserting financial statement audit readiness, DOD components must (1) confirm completeness of populations of transactions and address any abnormal transactions and balances, (2) test beginning balances, (3) perform key reconciliations, (4) provide timely and complete responses to audit documentation requests, and (5) verify that key IT systems are compliant with the Federal Financial Management Improvement Act. | Statement of Work for the Recovery Audit Program I. Purpose The Recovery Audit Program s mission is to reduce Medicare improper payments through the efficient detection and collection of overpayments the identification of underpayments and the implementation of actions that will prevent future improper payments. The purpose of this contract will be to support the Centers for Medicare Medicaid Services CMS in completing this mission. The identification of underpayments and overpayments and the recoupment of overpayments will occur for claims paid under the Medicare program for services for which payment is made under part A or B of title XVIII of the Social Security Act. The CMS expects that Recovery Auditors review all claim types to assist the Agency in lowering the error rate and in identifying improper payments that have the greatest impact on the Trust Fund. This contract includes the identification and recovery of claim based improper payments. This contract does not include the identification and or recovery of MSP occurrences in any format. This contract includes the following tasks which are defined in detail in subsequent sections of this contract 1. Identifying Medicare claims that contain underpayments for which payment was made under part A or B of title XVIII of the Social Security Act. This includes the review of all claim and provider types and a review of claims providers that have a high propensity for error based on the Comprehensive Error Rate Testing CERT program and other CMS analysis. 2. Identify and Recouping Medicare claims that contain overpayments for which payment was made under part A or B of title XVIII of the Social Security Act. This includes corresponding with the provider. This includes the review of all claim and provider types and a review of claims providers that have a high propensity for error based on the CERT program and other CMS analysis. 3. For any recovery auditor identified overpayment that is appealed by the provider .

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