What does CMS instruct recovery auditors to do when reviewing claims?

The Centers for Medicare & Medicaid Services (CMS) instructs recovery auditors to use the same payment policies as originally applied when reviewing claims. This is essential as it ensures consistency and fairness in the claims review process. By adhering to the initial payment policies, recovery auditors can accurately assess whether the claims were processed and paid correctly based on existing guidelines and regulations.

The importance of this approach lies in maintaining the integrity of the Medicare program and ensuring that providers are reimbursed based on the established criteria. This aids in building trust in the auditing process while allowing for a thorough examination of claims based on the standards set at the time of payment.

This guidance prevents arbitrary or subjective evaluations and focuses on the rules and pricing structures that had been in place, thus providing a balanced review mechanism that's vital for both providers and beneficiaries.