Medicare Recovery Audit Contractors are increasingly successful at finding overpayments, but the amount of underpayments the contractors unearth continues to dwindle, according to data from Centers for Medicare and Medicaid Services.
During the first six months of the RAC program in fiscal 2013, contractors recovered $1.37 billion in overpayments and returned $65.4 million in underpayments. In fiscal 2012, the contractors found $2.29 billion in overpayments and $109.4 million in underpayments. In fiscal 2011, as the program was being ramped up, contractors collected $797.4 million and returned $141.9 million. The data seems to indicate that the priority on collections--of which contractors retain a portion--has steadily increased since 2009.
The top medical issues that RACs focused on for finding overpayments from January to March 2013 were medical necessary questions around cardiovascular procedures in geographic Regions A, B and C, and medical necessity questions in Region 4 concerning minor surgery and other treatment billed as an inpatient stay. A chart of the data is available here.
Legislation recently introduced in both houses of Congress would impose new restrictions on RACs.
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