What is the time frame for Fee-For-Service Recovery Auditors to request claims after the payment date?

The correct answer reflects the guidelines established by the Centers for Medicare & Medicaid Services (CMS) regarding the timeframe for Recovery Audit Contractors (RACs) in a Fee-For-Service environment. Under these regulations, Recovery Auditors have a window of three years from the date of payment to review and potentially recover overpayments on claims. This period is intended to allow adequate time for a review of claims after payment has been made, ensuring that any discrepancies can be addressed while still being within a reasonable statutory limit.

The three-year period aligns with efforts to balance the needs of the healthcare providers and the government’s oversight of proper billing practices. Recovery Auditors can examine the claims data and verify the appropriateness of payments made during this timeframe, allowing for a thorough audit process.