Recovery audit contractors have recouped $797.4 million in alleged Medicare overpayments to health care providers and paid providers $141.9 million in underpayments since October 2010, according to a new report from the Centers for Medicare & Medicaid Services. CMS claims Medicare RACs collected $354 million in overpayments in the third quarter of fiscal year 2011 alone.
However, hospitals participating in the American Hospital Association's latest RACTrac survey report appealing about one in three claim denials, of which 77% were overturned on appeal. The CMS report does not reflect these overturned denials.
According to CMS, coding errors and a lack of sufficient documentation to support medical necessity were among the top overpayment issues cited in the four RAC regions. For more on the AHA survey, which provides additional information on medical necessity denials and the RAC program’s administrative burden, hospitals are invited to attend a Jan. 4 webinar. To register, click here.
Comments