Recovery auditors (RACs) corrected payments of $694.5 million in the quarter ending Sept. 30, bringing the fiscal year 2012 total to more than $2.4 billion.
That’s up from $939.3 million in payments corrected in fiscal year 2011, according to recently released CMS reports.
The majority of corrections continue to be overpayments, which accounted for almost $2.3 billion or 95 percent of the corrections in 2012. RACs corrected just $109.4 million in underpayments, the reports show.
The top issue in three of the four regions – A, B and C – was medical necessity for cardiology procedures. RACs are looking for documentation for patients undergoing cardiovascular procedures that is complete and supports all services provided in the setting billed, according to the issue description.
For Region D, the top issue was minor surgery and other treatment billed as inpatient: “When beneficiaries with known diagnoses enter a hospital for a specific minor surgical procedure or other treatment that is expected to keep them in the hospital for less than 24 hours, they are considered outpatient for coverage purposes regardless of the hour they presented to the hospital, whether a bed was used and whether they remained in the hospital after midnight.”
For more information on the payment corrections report, visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Recovery-Audit-Program/Recent_Updates.html.
Region A RAC Performant Recovery posted 15 issues for ambulatory surgical centers, durable medical equipment (DME) suppliers, laboratories, outpatient hospitals and physicians/non-physician practitioners. See the charts below for more details.
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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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