CMS identifies common issues uncovered by recovery audit contractors

According to the latest edition of the Centers for Medicare & Medicaid Services' (CMS) quarterly Medicare compliance newsletter, just three types of hospital, ambulance and durable medical equipment claims submitted to the agency for reimbursement resulted in more than 20,000 overpayments, recovery audit contractors (RACs) found.

More than 19,600 improper claims were submitted for two medications – Brovana and Perforomist – used to control the symptoms of chronic obstructive pulmonary disease. For many of the claims, the inaccuracy was caused by multiplying by the medication's dosage size as opposed to the number of prescribed units.

Recovery audits also identified more than 1,000 instances involving service providers failing to directly bill hospitals for their services, instead charging Medicare Part B. Additionally, the agency cautioned healthcare providers against overbilling for prosthetics and overadmission of patients for services that could be performed on an outpatient basis.

Earlier this month, CMS set the record straight about the roles of RACs and existing Medicaid integrity contractors (MICs). McKnight's explains that although their roles overlap somewhat – since both will be identifying irregularities such as overpayments, underpayments and duplicate payments – MICs will also provide information on fraud trends. 

Leave a Reply

Your email address will not be published. Required fields are marked *

Prove You're Human * Time limit is exhausted. Please reload the CAPTCHA.