CMS collection plate taking back millions in overpayments

The Centers for Medicare & Medicaid Services (CMS) recently announced payment corrections, totaling $684.8 million. As some hospitals already are struggling with cut reimbursements, CMS this quarter collected overpayments worth $233.4 million, compared to returning $55.9 million in underpayments.

Under the Tax Relief and Health Care Act of 2006, recovery auditor contractors (RACs) identify and correct inappropriate payments. CMS released the following data this month.

 

FY 2010

FY 2011 Q1

FY 2011 Q2

FY 2011 Q3

Total national program

Overpayments collected

$75.4 M

 

$81.2 M

$185.2 M

$233.4 M

$575.2 M

Underpayments returned

$16.9 M

$13.1 M

$23.7 M

$55.9 M

$109.6 M

Total corrections

$92.3 M

$94.3 M

$208.9 M

$289.3 M

$684.8

Compared to 2010 and previous quarters, the data may indicate that CMS is increasing its collection efforts, beefing up so-called "RAC attacks."

"RAC's are taking advantage of their ability to run automated reviews around the clock on much less cost than a complex review not yielding big dollars. Just because a hospital is not getting record requests, don't assume that you are not being audited and losing money," said Elizabeth Lamkin, partner, PACE Healthcare Consulting, LLC, in a Revenue Cycle Institute article.

For more information:
- read the Revenue Cycle Institute article
- check out the CMS report (.pdf)

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