From October 2009 through the first quarter of the 2012 fiscal year, the Medicare Recovery Audit program has collected a total of $1.27 billion in overpayments, according to a CMS fact sheet (pdf).
During that same time frame, CMS has returned $183.7 million in underpayments, resulting in nearly a 7-to-1 ratio of overpayment dollars to underpayment dollars. RACs are currently on pace to shatter last year's total of $797.4 million in overpayments, as they have already collected $397.8 million through the quarter ended Dec. 31, 2011.
In the first quarter of FY 2012, CMS noted three main overpayment issues: neurological disorders, cardiovascular procedures and minor surgery and other treatment billed as an inpatient stay. All three issues involved medical necessity review for inpatient treatment. CMS did not disclose the most common issues for underpayments.
Here is a complete breakdown of RAC data over the past two-plus years:
Overpayments collected:
FY 2010 — $75.4 million
FY 2011 — $797.4 million
FY 2012 Q1 — $397.8 million
Total — $1.27 billion
Underpayments returned:
FY 2010 — $16.9 million
FY 2011 — $141.9 million
FY 2012 Q1 — $24.9 million
Total — $183.7 million
Total corrections:
FY 2010 — $92.3 million
FY 2011 — $939.3 million
FY 2012 Q1 — $422.7 million
Total — $1.45 billion
During that same time frame, CMS has returned $183.7 million in underpayments, resulting in nearly a 7-to-1 ratio of overpayment dollars to underpayment dollars. RACs are currently on pace to shatter last year's total of $797.4 million in overpayments, as they have already collected $397.8 million through the quarter ended Dec. 31, 2011.
In the first quarter of FY 2012, CMS noted three main overpayment issues: neurological disorders, cardiovascular procedures and minor surgery and other treatment billed as an inpatient stay. All three issues involved medical necessity review for inpatient treatment. CMS did not disclose the most common issues for underpayments.
Here is a complete breakdown of RAC data over the past two-plus years:
Overpayments collected:
FY 2010 — $75.4 million
FY 2011 — $797.4 million
FY 2012 Q1 — $397.8 million
Total — $1.27 billion
Underpayments returned:
FY 2010 — $16.9 million
FY 2011 — $141.9 million
FY 2012 Q1 — $24.9 million
Total — $183.7 million
Total corrections:
FY 2010 — $92.3 million
FY 2011 — $939.3 million
FY 2012 Q1 — $422.7 million
Total — $1.45 billion
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