Medicare RACs Recoup $2.2B in Past 6 Months

From July through December 2013, Medicare recovery auditors have collected almost $2.25 billion from hospitals and other providers, according to the latest figures from CMS.

That total equates to the amount of overpayments recouped in the first nine months of the 2013 federal fiscal year, which ended June 30.

Of the $2.25 billion in Medicare take-backs in the past six months, $1.43 billion were collected in the federal fourth quarter, which ended Sept. 30. That means in the federal government's 2013 fiscal year, Medicare RACs recouped $3.67 billion, the most of any single year since the program officially started four years ago. CMS did not identify how much of those recoupments were tied up in the appeals process or had been successfully appealed by providers.

In the first quarter of FY 2014, ended Dec. 31, Medicare RACs collected $816 million in overpayments. Only $88.1 million in Medicare underpayment were returned to providers.

Medical necessity of cardiovascular procedures remained as the top overpayment issue for RACs. Minor surgery and other treatments billed as inpatient when they should have been billed as outpatient or observation was the other top overpayment reason. CMS did not disclose the most common issues for underpayments.

More Articles on Medicare RACs:
CMS Announces 5 Changes to RAC Program, Halts Documentation Requests
Coalition Asks HHS to Reform Medicare RAC Appeals Process
5 Big Mistakes Hospitals Make When Dealing With RAC Audits

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