Revenue Cycle

CMS posts year-end improper payment figures, top issues by region

Medicare Update for CAHs, March 7, 2012

On February 9, CMS posted its latest recovery auditor update. The results show a continuing trend toward increasing improper payment collections.

For the time period October 1, 2011 to December 30, 2011, CMS identified $397.8 in overpayments and $24.9 million in underpayments for a total of $422.7 million in improper payments. As has been the case for each quarter, these numbers are higher than any prior one; the previous mark of $277.1 million in overpayments and $76.6 million in underpayments, for a total of $353.7 million, was set in July through September 2011.

Since the national program began in October 2009, CMS has identified a total of $1.27 billion in overpayments and $183.7 million in underpayments for a total of $1.45 billion in total corrections. The total correction amounts of each quarter of the program are as follows:

  • October 2009–September 2010: $92.3 million
  • October 2010–December 2010: $94.3 million
  • January 2011–March 2011: $208.9 million
  • March 2011–June 2011: $289.3 million
  • July 2011–September 2011: $353.7 million
  • October 2011–December 2011: $422.7 million

Medical necessity issues remained the top target of each individual recovery auditor for the second straight quarter. Three of the four identified issues are the same—with only DCS Healthcare (Region A) having identified a new top CMS-approved issue—while HealthDataInsights (Region D) maintained the same top issue for the third straight quarter:

  • Region A: Neurological disorders (Medical necessity)
  • Region B: Surgical cardiovascular procedures (Medical necessity)
  • Region C: Acute inpatient admission neurological disorders (Medical necessity)
  • Region D: Minor surgery and other treatments billed as inpatient (Medical necessity)

To view the year-end report, click here: http://www.cms.gov/Recovery-Audit-Program/Downloads/FY2012NationalProgramCorrections_vj.pdf

To view the previous report, click here: http://www.cms.gov/Recovery-Audit-Program/Downloads/FY2011QtrlyReport.pdf

To stay on top of the latest RAC-approved issues in your state, visit the Revenue Cycle Institute website.

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