Hospitals Should Assume Overpayment Amounts in Demand Letters Are Estimates Only

As of April 1, Region C recover audit contractor Connolly Consulting stopped including recovery amounts for overpayments in its demand letters. The contractor previously included projected recovery amounts but stopped this practice after realizing it and the Region C MAC contractors were using different calculation tools, leading to significant differences between the estimated amount and the actual recoupment amount from the MAC, according to a blog post by J. Paul Spencer, compliance officer for Fi-Med, and author of The RAConteur blog.

“One wonders why CMS missed the important step of verifying that the dollar amounts from the RACs and the MACs matched,” he states.

In response, Mr. Spencer recommends providers compare the amounts of review letters to those recouped by RACs. “Go forward on the assumption that the amounts determined by the RACs are estimates only,” he says.

Read the blog post here.

Related Articles by J. Paul Spencer:
8 Actions Hospitals Can Take to Protect Against RACs
As Denials Rise, Hospitals Working Harder to Fend Off RACs

Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit

Next Up in Financial Management

Hospitals Should Assume Overpayment Amounts in Demand Letters Are Estimates Only

Next Up in Financial Management

43% of hospitals are in the red: 6 financial notes

'Medicare for All' gets its moment

Trinity Health Mid-Atlantic CEO: 'You can't cut your way to success'

Next Up in Financial Management

Join the 500,000+ healthcare executives who start their day with Becker's