The Centers for Medicare and Medicaid Services (CMS) on Feb. 28 announced that $371.5 million in improper Medicare payments has been collected from or repaid to healthcare providers and suppliers as part of a demonstration program using recovery audit contractors (RACs) in California, Florida, and New York in 2007. Nearly $440 million has been collected since the program began in 2005.
The RAC demonstration program is intended to find and correct improper Medicare payments paid to healthcare providers participating in fee-for-service Medicare. Approximately 96 percent of the improper payments identified by the RACs in 2007 were overpayments collected from healthcare providers; the remaining 4 percent were underpayments repaid to healthcare providers.
“It appears that the recent CMS RAC status document may overestimate the net benefits of the RAC program,” commented Robert Corrato, MD, president and CEO of Executive Health Resources, Inc., Newtown Square, Pa. “Of note, the low RAC denial appeal and overturn rates are based only on information up to October 2007, not taking into account more recent appeals. The low appeal rate further underscores the challenges that providers face in not knowing how to conduct an effective appeal or how to manage the operational and economic barriers of the appeal process.” Corrato will speak on the topic of RAC audit preparedness plans at HFMA’s ANI June 23-26 in Las Vegas.
Read the press release.
