CMS' Medicare Recovery Auditors (RACs) collected $397.8 million in overpayments from hospitals and other healthcare providers in the first quarter of fiscal year 2012, and analysts at revenue cycle firm Craneware predict these "take-backs" are only going to increase in the months and years ahead.
The first quarter recoupment total is roughly half the amount RACs collected in all of FY 2011 ($797.4 million) and more than 10 times the overpayment recoveries collected in FY 2010 ($75.4 million). However, in the American Hospital Association's fourth quarter RACTrac Survey, roughly 74 percent of hospitals were successful in the appeals process of a RAC denial.
In addition to the increasing RAC overpayment totals, Craneware executives believe the growing demand for claims information will lead to a greater emphasis on compliance in healthcare, as providers look to support and manage more audits.
"As Recovery Auditors escalate their reviews across healthcare organizations of all sizes, these audits are greatly impacting financial performance, driving the need for providers to ensure revenue integrity," said Craneware CEO Keith Neilson in the release. "Now more than ever, the entire healthcare industry is looking to adopt methodologies and processes that ensure charge compliance and reduce payment recoupment."
The first quarter recoupment total is roughly half the amount RACs collected in all of FY 2011 ($797.4 million) and more than 10 times the overpayment recoveries collected in FY 2010 ($75.4 million). However, in the American Hospital Association's fourth quarter RACTrac Survey, roughly 74 percent of hospitals were successful in the appeals process of a RAC denial.
In addition to the increasing RAC overpayment totals, Craneware executives believe the growing demand for claims information will lead to a greater emphasis on compliance in healthcare, as providers look to support and manage more audits.
"As Recovery Auditors escalate their reviews across healthcare organizations of all sizes, these audits are greatly impacting financial performance, driving the need for providers to ensure revenue integrity," said Craneware CEO Keith Neilson in the release. "Now more than ever, the entire healthcare industry is looking to adopt methodologies and processes that ensure charge compliance and reduce payment recoupment."
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