RI Indicates Recovery Auditor Appeal Adjustments
Effective December 29, 2014 Medicare administrative contractors can append Adjustment Reason Code RI “to all Part A (FISS) claim adjustments related to Recovery-Auditor post-payment review activities, including those resulting from appeal decisions that result in full or partial overturns of RA decisions,” according to the Centers for Medicare & Medicaid Services (CMS) Change Request (CR) 8973. For Part B claim adjustments, use a plus sign (+) in the second position of the Reason/Discovery code “to identify all Part B (MCS) claim adjustments related to Recovery Auditor post-payment review activities,” including those arising from appeal decisions resulting in full or partial RA decision overturns.
Reporting in this manner will help CMS track appeal outcomes for reporting and for provider and contractor payment purposes.
See CR 8973 for more information.