A controversial Medicare program has recovered $1 billion in improver payments made since 2005, for a net gain of $693.6 million for the government, even though hospitals and members of Congress remain skeptical of its motive and methods.
In a report on its recovery audit contractor, or RAC, program, the CMS found most of the improper payments were from 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.
According to the CMS, inpatient hospitals accounted for 85% of the financial haul, with outpatient providers and inpatient rehabilitation facilities accounting for the rest.
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 Don May, vice president for policy at the American Hospital Association, said that the CMS made some significant steps to improve the program over time. ... And we still have other improvements that need to occur before this program rolls out.
May said the CMS should stop paying its contractors on a contingency fee basis for the review of medical necessity claims, which account for a big portion of the audits.
Meanwhile, Democratic congressmen asked the Government Accountability Office to investigate the CMS oversight of the program and preventive measures it may have taken to stop future improper payments.