More than 180 NJHA members participated in an introductory webinar with HMS Federal Solutions, the new New Jersey Medicare Recovery Audit contractor, and Novitas Solutions, the Medicare Administrative Contractor for New Jersey.

A recording of the webinar is available online.

Highlights from the webinar include:

• HMS Federal Solutions expects its updated website to be available for providers within the next few weeks. In the meantime, providers should monitor the existing web site for updates and information.
• The first additional documentation requests (ADRs) are expected to go out to providers in mid-May.
• As in the past, there will be both automated reviews, which do not require submission of medical records, and complex reviews which will require medical record submission.
• The initial look-back period is three years.
• The new annual ADR limit baseline is one half of one percent (0.5 percent) of the provider’s total number of paid Medicare claims from a previous 12-month period. After three ADR cycles (45 days each), the Centers for Medicare and Medicaid Services will calculate a provider’s denial rate which will be used to adjust the provider’s ADR limit. The RAC can then decide whether to conduct reviews based on the adjusted ADR limit with a six-month look-back period or based on the baseline annual ADR limit with a three-year look-back period.
• The provider portal will be able to accept additional contacts, up to seven per organization, as well as username and password resets after the providers’ current information is completely migrated to the new web site.
• Novitas reviewed the denial and overpayment process as well as the appeals process.