Medicare said it has recouped more than $1 billion since 2005 under a federal pilot program that uses independent contractors to ferret out improper provider payments, with hospitals accounting for 85% of the financial haul.
In a report issued Friday regarding its recovery audit contractor, or RAC, program, the CMS found that most of the improper payments were made because of billing and coding errors, often when a single procedure was billed multiple times. Other snafus included incorrectly coded procedures and the submission of duplicate claims that resulted in double payments.
Acting CMS Administrator Kerry Weems lauded the results and called the program a success. We need to ensure accurate payments for services to Medicare beneficiaries, Weems said in a statement. With a permanent program, people with Medicare can be assured they are being charged correctly for their share of their healthcare services, he said in reference to the RAC program.
But the report also documents many changes that the CMS plans for the program. One of the key changes is that the CMS changed the look-back time from a four-year window to a three-year window, said Don May, vice president of policy at the American Hospital Association. Were generally supportive of the changes that they made to address our concerns, May said. But, he added, They dont go far enough in some cases and we still have other improvements that need to occur before this program rolls out. (For a longer version of this story, please click here.) -- by Matthew DoBias