Case Management

News: CMS releases report on RAC improper payments

Case Management Weekly, May 4, 2011

CMS released a recovery audit contractor (RAC) update about total improper payments since the RAC demonstration.

From October 2009 through the end of March 2011, RACs have identified $312.2 million in overpayments and $52.6 million in underpayments, totaling $365.8 million in total improper payments.

CMS also highlighted the top RAC issue per RAC region from FY2010 through March 2011.

  • Region A: improperly adding ventilator hours, resulting in higher reimbursement
  • Region B: billing incorrect principal and/or secondary diagnosis, resulting in incorrect MS-DRG assignment
  • Region C: billing bundled durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services separately
  • Region D: billing bundled DMEPOS services separately

Source:  CMS

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