CMS RACing up recoveries
85% overturned in favor of providers, AHA says
The American Hospital Association said last week that it is pleased the CMS has released data on what it has recouped in improper Medicare payments, but would still like to see information about the appeals process in the agency’s recovery audit contractor program.
On April 26, the CMS issued the first of what it expects will be quarterly reports on the Medicare fee-for-service recovery audit program since it became a permanent national program last year. Designed to weed out fraud and abuse, the RAC program relies on four contractors—Diversified Collection Services, CGI Inc., Connolly Inc. and HealthDataInsights—to identify improper payments on claims to Medicare beneficiaries in four geographic regions of the country.
The report last week showed that from October 2009 until March 2011, the program had identified and recouped a total of $313.2 million in improper payments, with more than half of that amount— $162 million—collected in the first quarter of this year alone. This amount represents payments from all providers, not only hospitals, according to the CMS. Common issues for overpayments included improper coding and billing for bundled services separately.
Meanwhile, about $52.6 million in underpayments were returned to providers in that period, including $22.6 million between January and March of this year. Some providers, however, have yet to receive those funds.
Elizabeth Baskett, senior associate director for policy at the AHA, said the association monitors this and other issues related to the RAC program in AHA’s RACTRAC, an online tool that provides information and surveys hospital members about the program.
“In that process, they share issues and a common concern that has been raised is that