Medicare recovery audit contractors in the national RAC program, which started 18 months ago, made just over half of their recoveries just from January to March of this year, according to a release by CMS.
The national program has collected a total of $313.2 million since it started in Oct. 2009, and $162.0 million of those funds were collected just in the recent three-month period. In comparison, the RAC demonstration program, which started in March 2005, collected $992.7 million in overpayments in three years.
The national program has surpassed the demonstration program in identifying Medicare underpayments and retuning them to hospitals and other providers. RACs in the national program identified underpayments worth $52.6 million, compared with $37.8 million in the demonstration program.
Here CMS identifies the top issues for each RAC since the national program started.
Region A (Diversified Collection Services): Ventilator Support of 96+ hours. Denied claims involved improperly billing for a number of ventilator hours that qualify for higher reimbursement. Clocking ventilation hours begins with the intubation or time of admittance if the patient is admitted with mechanical ventilation and end when the endotracheal tube is removed, the patient is discharged or transferred, or the ventilation is discontinued after a weaning period.
Region B (CGI): Extensive Operating Room Procedure Unrelated to Principal Diagnosis. Denials involved billing an incorrect principal or secondary diagnosis, resulting in an incorrect Medicare Severity DRG payment. The principal diagnosis and principal procedure codes for this inpatient claim have to be related.
Region C (Connolly): Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided During an Inpatient Stay. This overpayment involves billing separately for services that should be bundled. Medicare does not make separate payment for such equipment.
Region D (HealthDataInsights): Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided During an Inpatient Stay. Same issue.
Read the CMS report on RACs.
The national program has collected a total of $313.2 million since it started in Oct. 2009, and $162.0 million of those funds were collected just in the recent three-month period. In comparison, the RAC demonstration program, which started in March 2005, collected $992.7 million in overpayments in three years.
The national program has surpassed the demonstration program in identifying Medicare underpayments and retuning them to hospitals and other providers. RACs in the national program identified underpayments worth $52.6 million, compared with $37.8 million in the demonstration program.
Here CMS identifies the top issues for each RAC since the national program started.
Region A (Diversified Collection Services): Ventilator Support of 96+ hours. Denied claims involved improperly billing for a number of ventilator hours that qualify for higher reimbursement. Clocking ventilation hours begins with the intubation or time of admittance if the patient is admitted with mechanical ventilation and end when the endotracheal tube is removed, the patient is discharged or transferred, or the ventilation is discontinued after a weaning period.
Region B (CGI): Extensive Operating Room Procedure Unrelated to Principal Diagnosis. Denials involved billing an incorrect principal or secondary diagnosis, resulting in an incorrect Medicare Severity DRG payment. The principal diagnosis and principal procedure codes for this inpatient claim have to be related.
Region C (Connolly): Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided During an Inpatient Stay. This overpayment involves billing separately for services that should be bundled. Medicare does not make separate payment for such equipment.
Region D (HealthDataInsights): Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Provided During an Inpatient Stay. Same issue.
Read the CMS report on RACs.