Q1 Corrections for FY 2013 Hit $779.2 Million

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Original story posted on: January 25, 2013

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Region C recovery auditor (RAC) Connolly corrected $255.4 million in claims in the first quarter of fiscal year 2013 – the most by any RAC in that period.

The total corrections for that quarter, which runs from Oct. 1 to Dec. 31, 2012, reached $779.2 million, CMS reports.

Region D RAC HealthDataInsights corrected $225.9 million in claims, Region A RAC Diversified Collection Services corrected $176.5 million and Region B RAC CGI Federal corrected $121.4 million, CMS states.

As usual, overpayments collected were far higher than underpayments returned. Diversified Collection Services’ overpayments accounted for 94 percent of its corrections, CGI’s accounted for 98 percent, Connolly’s accounted for 96 percent and HealthDataInsights’ accounted for 96 percent.

Medical necessity of cardiology procedures was the top issue for RACs in regions A, B and C. For Region D, “minor surgery and other treatment billed as inpatient” was the top issue.

For more on the first quarter’s results, visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Recovery-Audit-Program/Downloads/Medicare-FFS-Recovery-Audit-Program-1st-qtr-2013.pdf.

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About the Author

Karen Long is the editor of Physician Solutions for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

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