Revenue Cycle

CMS releases latest Recovery Auditor improper payment figures

Recovery Auditor Report, October 4, 2012

Following the close of each fiscal year (FY) quarter, CMS releases statistics for the amount of overpayments and underpayments made each quarter. In the latest report, the fiscal year 2012 trend continues to point upward, as CMS has once again corrected more improper payments than the previous quarter, this time to the tune of $701.3 million.

The report shows that, in the latest quarter, CMS collected $657.2 million in overpayments and $44.1 million in underpayments to combine for the $701.3 million total. In the previous quarter, CMS identified $588.4 million in overpayments and $61.5 million in underpayments for a total of $649.9 million in corrections. Since October 2009, CMS has corrected a grand total of $2.8 billion in improperly billed Medicare claims.

The upward trend continues to show that providers must get their billing and documentation shored up on the front end, says Elizabeth Lamkin, MHA, CEO, Pace Healthcare Consulting, LLC, in Hilton Head, S.C.

“Put the bulk of your care management staff and resources on the front end with bed status determination [inpatient or observation], use second-level physician advisor reviews, and have a clinical documentation improvement specialist reviewing concurrently,” she says.

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