Corporate Compliance

Examine short stays, avoid overpayment

Strategies for Health Care Compliance, December 1, 2008

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When the recovery audit contractor (RAC) demonstration project ended March 27, the evaluation report revealed difficulties with medically unnecessary services or settings. Services or settings that RACs deemed unnecessary accounted for more than 40% of the $992.7 million in Medicare overpayments they uncovered during the pilot run. This category includes claims for services a provider renders in medically unnecessary settings, such as an admission for inpatient care when the patient required only outpatient care.

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