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RAC Recoveries Continue To Climb in FY 2011 Q3

The Centers for Medicare & Medicaid Services (“CMS”) recently released the Medicare Fee-For-Service Recovery Audit Program (“RAC”) statistics for the third quarter of the fiscal year (“FY”) 2011. $233.4 million of overpayments was collected during that time period. In comparison, only $55.9 million of underpayments was returned during the same three month period. The latest recoveries bring the total amount of overpayments collected by the national program to $575.2 million since October 2009, while the total amount of underpayments returned since October 2009 is now at $109.6 million. Top overpayment issues during the third quarter included medical necessity, incorrect coding, and billing for bundled services separately. The CMS report may be viewed here.

RAC overpayment and underpayment corrections continue to vary between the four RAC regions. Region D correction totals ($145.9 million) were significantly higher and approximately equaled the correction totals of Regions A, B, and C combined ($143.4 million). Further details may be viewed here.

For assistance appealing a claim denial or for more information, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510. More information may also be obtained at the HLP website.

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