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CMS publishes improper payment figures and appeals statistics

Patient Access Weekly Advisor, June 20, 2012

In the last month, CMS posted two separate sets of data that provide nationwide statistics on its Recovery Auditor program. The first update contains improper payment figures as well as the top Recovery Auditor issue per region. In the second update, CMS provides appeals statistics for fiscal year 2011.

Improper payment figures and top issues

Recovery Auditor activity saw a huge spike in the latest quarter, as statistics for overpayments and underpayments both saw significant increases. For the time period January 2012 through March 2012, CMS identified $588.4 million in overpayments and $61.5 million in underpayments for a total of $649.9 million in corrections. These numbers are up from $397.8 million and $24.9 million from last quarter, respectively. These numbers have climbed considerably since the start of the permanent program.

Since the beginning, CMS has identified $1.86 billion in overpayments and $245.2 million in underpayments for a sum of $2.1 billion in total corrections.

The 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
• January 2012 – March 2012: $649.9 million

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