CMS releases latest recovery audit statistics

According to a recently released report by the Centers for Medicare & Medicaid Services, the recovery audit contractor has corrected nearly $685 million in improper payments since fiscal year 2010.

Specifically, $185.2 million was collected in the second quarter of FY2011 and $233.4 million was recouped between March and June of this year. This is a significant rise in overpayments compared to the $75.4 million recovered between October 2009 and September 2010.

Auditors identified the top issues related to overpayment in their regions as input of unrelated principal diagnosis and procedure codes for an inpatient claim, incorrectly billing minor surgery and other treatment as inpatient and billing for bundled services separately.

According to a recent report by Becker's Hospital Review, leveraging business process automation techniques may help healthcare facilities deal with increased scrutiny from RACs by expediting claims processing while improving accuracy levels and decreasing the amount of training and support staff needed to be able to complete tasks effectively.

The news source reports that automation allows complex claims to be more easily managed, reducing the percentage of variance and thereby decreasing the likelihood of an audit.


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