CMS reveals RAC audit hotspots

Recovery audit contractors (RAC) discovered more than 20,000 overpayments for just three types of hospital, ambulance and durable medical equipment claims submitted to the Centers for Medicare & Medicaid Services for reimbursement, according to a January newsletter.

CMS reported more than 19,600 improperly submitted payment claims for Brovana and Perforomist, two medications used to control the symptoms of chronic obstructive pulmonary disease. CMS has since collected the overpayments.

RAC auditors found numerous claims submissions whose improper billing was reached by multiplying by the dosage size of the medication rather than by the number of units prescribed to the patient.

Among ambulance companies and hospitals, auditors discovered more than 1,000 instances where the service provider was billing Medicare Part B for its services rather than the hospital directly. Overpayments have also been collected in those instances.

CMS also warned of admitting too many patients for evaluations when they could have performed the services on an outpatient basis, as well as overbilling for prosthetic limbs and accessories.

To learn more:
- read the AHA News Now brief
- read the Medicare newsletter (.pdf)

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