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California Hospital Association questions CMS numbers from demonstration project

Recovery Auditor Report, September 4, 2008

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As we reported in the last edition of The RAC Report, CMS released its “Summary Evaluation Report” on the RAC demonstration project, where it said it identified $992.7 million in overpayments.

The California Hospital Association released a memorandum to HCPro Inc. that cites “several serious concerns” about the information in the CMS report, such as:

• The appeals data is incomplete, and significantly understates the volume and impact of provider appeal activity. The current report does not include appeals at the first level of appeal or other appeals in process with providers.
• The total appeals volume data is premature and misleading. Nearly one half (47%) of the reported “overpayments” were recouped during the last three months of the program (January 1, 2008 through March 27, 2008). This significant portion of total funds collected was still subject to appeal at the time of the report (May 1, 2008).

For more on the California Hospital Association’s take on CMS RAC numbers, please see the next edition of The RAC Report on September 18.

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