Which term describes the process of auditing CMS claims to recover improper payments?

• A. Payment review
• B. Recovery Audit
• C. Prepayment verification
• D. Compliance audit

Answer: (B)

The main concept here is recovering money that CMS paid in error by reviewing claims after they’ve already been paid. This is exactly what a recovery audit does. Recovery audits are a post-payment review process used by CMS (often through Recovery Audit Contractors) to identify improper payments on paid claims and recoup those funds, sometimes with interest. They look for issues like coding inaccuracies, medically unnecessary services, or billing for non-covered items, and the goal is to correct past overpayments and reduce future errors by informing edits and guidance.

This differs from prepayment verification, which aims to stop improper payments before they occur, and from a general compliance audit, which assesses overall adherence to rules rather than specifically reclaiming overpaid funds. Payment review is a broader or less formal-sounding term, not the established program name for recouping overpayments.