CMS releases results of RAC demonstration
Compliance Monitor, July 16, 2008
Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!
Recovery Audit Contractors (RACs) corrected more than $1.03 billion in improper Medicare payments, according to a CMS evaluation of the RAC pilot program..
The purpose of the program was to identify underpayments and overpayments under Parts A and B of the Medicare program. The demonstration began with the three largest states in terms of Medicare utilization: California, Florida, and New York. In 2007, Massachusetts, South Carolina, and Arizona were included for the remainder of the demonstration.
The pilot results showed that of the improper payments identified by RACs, 96% were overpayments collected from the providers and 4% were underpayments, repaid to providers.
CMS drew several conclusions stemming from these results in its evaluations, including:
- The cost to run the RACs program is less than the amount returned to the Medicare Trust Fund. The total cost was $.20 for each dollar collected.
- Providers did not appeal every RAC overpayment determination. Only 14% were appealed and 4.6% were overturned.
- It is administratively possible to pay RACs on a contingency fee basis.
Based on problems that occurred during the demonstration, CMS will make these changes to the permanent program:
- RACs will only look back as far as October 1, 2007. A four-year look back period was too long.
- RACs will be required to hire a physician medical director to oversee the medical record review process, assist nurses and coders, and manage quality assurance procedures. Providers believe the lack of physicians present at the RAC audit resulted in erroneously denied claims.
- RAC contingency fees will be disclosed. In the pilot program, CMS did not disclose RAC contingency fees, resulting in apprehension from providers.
To read the full RAC report, click here
Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!
Comments
0 comments on “CMS releases results of RAC demonstration ”
Related Products
-
Strategies for Health Care Compliance
News and real-life examples to increase the effectiveness of your compliance program. Strategies for Health Care Compliance...
-
Compliance Monitor
This HTML e-mail newsletter delivers news on Medicare and Medicaid fraud and abuse, as well as recent documents and targets...
-
Medicare Weekly Update
Each issue of Medicare Weekly Update includes the latest CMS proposed and final rules, CMS manual revisions, and...
-
Medicare Update for Physician Services
Medicare Update for Physician Services is a free, monthly e-zine that delivers news and information to help physician...
Most Popular
- Articles
-
- HIPAA Q&A: Level of encryption needed for email
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- Capturing all necessary codes for IUD insertion and removal can be challenging
- Topic: CMS, OESS post new security compliance review information, checklist
- What does case-mix index mean to you?
- Q&A: Acute respiratory failure diagnosis does not require intubation
- OB services: Coding inside and outside of the package
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- HIPAA Q&A: Level of encryption needed for email
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- CMS has reformulated payments for some bilateral procedures
- Oxygen Cylinder Storage Requirements
- Q&A: Follow CMS' coding guidelines when using modifier -25
- Understand the spine to code back procedures correctly
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- New conflicts of interest create new challenges
- Searched