CMS reported that recovery auditors identified and corrected about $75.4 million in overpayments and about $16.9 million in underpayments in the agency's first report to Congress on the National Recovery Audit program.
CMS reports to Congress on recovery auditors
All recovery auditors began reviewing claims in October 2009, and the total amount of $92.3 million in overpayments and underpayments for fiscal year 2010 represents collections in four regions by four recovery auditors: $5.9 million from Diversified Collection Services in Region A; $15.5 million from CGI in region B; $27.5 million from Connolly in region C and $43.4 million from HealthData Insights in region D.
Auditors reported that some overpayment issues were due to incorrect coding and billing for bundled services separately.
These figures show what has already been collected or restored to providers in the past fiscal year. CMS also reported that another factor of the RAC programs success is the amount demanded in fiscal year 2010. Demanded or identified improper amounts are those that healthcare providers submitted but have yet to be collected or restored. For fiscal year 2010, that figure was about $135.6 million in overpayments, the report said.
The permanent RAC program developed after a recovery auditor demonstration in six states from March 2005 to March 2008 proved successful. While the program currently identifies improper payments for claims under Medicare parts A and D, last year's Patient Protection and Affordable Care Act expanded the program to include parts C and D in the future. According to the report, CMS has “initiated implementation of Part C and Part D RACs” by awarding a contract for Part D recovery auditing in January 2011, and by seeking comments on how best to implement the Parts C and D program through a request for information published on Dec. 27, 2010.
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