CMS reports decrease in identified overpayments

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Friday, December 16, 2016

WASHINGTON – Recovery audit contractors identified and corrected nearly $441 million in improper payments in Fiscal year 2015—a decrease of 82.8% compared to 2014.

In a new report to Congress, “Recovery Auditing in Medicare Fee-For-Service for Fiscal year 2015,” CMS attributes the decrease to the prohibition on the RACs performing patient status reviews on inpatient hospital claims. Collections on inpatient claims were $2.02 billion in FY 2014 compared to $225.18 million in FY 2015.

The RACs were able to return a net of $141.87 million to the Medicare Trust Fund in FY 2015, although those savings don’t take into account program and administrative costs incurred at the third and fourth levels of appeal.

Throughout the four levels of appeals, a total of 170,482 appeal decisions were rendered for claims with overpayments in FY 2015. Of the appeals decided, 63,647 (37.3%) of claims were overturned in the provider’s favor.

For DME claims, specifically, 8,302 appeals were reported, 2,366 were dismissed and 5,515 (66.4%) were overturned.