What will a provider receive if an improper payment is identified by a Recovery Auditor?

When a Recovery Auditor identifies an improper payment, the provider will receive a decision and rationale review letter. This letter outlines the auditor's findings, detailing the reasons for the identified improper payment. It serves as a formal communication to the provider, explaining the basis for the recovery action and providing insights into the auditing process.

This letter is important because it not only informs the provider of the issue but also allows them an opportunity to review the findings and, if necessary, respond to the audit results. By providing the decision along with the rationale, the auditor fosters transparency in the auditing process and ensures that providers understand the criteria used to assess the payment accuracy.

This process is distinct from other potential communications that might be sent in different scenarios, such as notices of payment adjustments or claim denials, which serve different purposes and do not typically provide the comprehensive rationale that is offered in a decision and rationale review letter.