RCM tip of the day: CMS results on RAC program highlight potential new revenue

Results from CMS' Medicare Recovery Audit Contractor program suggest using a similar process to audit other insurers could potentially result in new revenue for providers, according to Julie Vigue, strategic business development executive at eVOLUTIONcr.

Ms. Vigue shared the following tip with Becker's Hospital Review.

"In January 2011, the RAC program was initiated to identify improper Medicare Part D payments that could be costing the government several millions of dollars. According to the fiscal year 2015 report, the RACs identified and corrected $440.69 million in improper payments. There were $359.73 million collected in overpayments and $80.96 million in identified underpayments paid back to providers.  

"CMS will continue to audit payments to reclaim overpayments and restore underpayments in a ratio that seemingly benefits CMS far greater than the providers. The next opportunity for identifying revenue streams may reside in an audit process for all insurance payers."

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.   

 

More articles on healthcare finance:
CMS terminates Kansas hospital's Medicare billing privileges: 5 things to know
Henry Ford's operating gains partially offset by Epic implementation costs, wage rate increases
9 health systems with strong finances

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months