Health Information Management

News: CMS says more than $700 million in improper payments corrected

CDI Strategies, October 11, 2012

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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 FY 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 last 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 recommends.
Accompanying this CMS release was a report that also detailed the amount of improper payments collected in each individual Recovery Auditor region. Region C, Connolly Healthcare, corrected the most, dollar-wise, from previous quarter, having identified a total of $229.1 million in improper payments.
In other Recovery Auditor news, Diversified Collection Services, Inc. (DCS) the Recovery Auditor for Region A, changed its name to Performant Recovery, Inc., a subsidiary of Performant Financial Corporation. Performant added complex acute care hospital-to-hospital transfers to its CMS-approved list of reviews to identify overpayments resulting from transfers incorrectly reported as discharges.
Editor’s Note: This article originally published on the Revenue Cycle Institute.

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