CMS publishes RAC results

Thursday, February 7, 2013

WASHINGTON – Medicare’s Recovery Audit Contractors (RACs) identified $939.3 million in improper payments in fiscal year 2011, according to a report issued by Health and Human Services Secretary Kathleen Sebelius on Feb. 5. 

Included in that number: 295,990 HME claims representing $34 million in overpayments, and 166 HME claims representing $12,400 in underpayments. 

The report also delves into how many claims were appealed and overturned in FY 2011.

“Medicare providers appealed 60,717 claims, which constitute 6.7 percent of all claims with overpayment determinations,” it states. “Of those claims appealed, 26,469 claims were overturned (43.6 percent).”

Though Sebelius calls the program “successful,” she acknowledges the need for improvements, including working more closely with Medicare Administrative Contractors (MACs) to improve understanding of coverage policies.

“CMS is sensitive to the concerns of the provider and supplier communities and continues to work with these communities to reduce the burden of the review process,” the report states. 

Other key facts in the report: 

• FFS Recovery Audit program returned $488.2 million to the Medicare Trust Funds.

• CMS spent $129.4 million to operate the Medicare FFS Recovery Audit Program, of which $81.9 million were contingency fees paid to RAC auditors. 

Read the full report here.