Recovery audit contractors in the national RAC program have collected more than $313 million since the program was implemented in October 2009, according to Becker's Hospital Review. More than half of the funds – $162 million – were collected in the first three months of 2011.
The main overpayment issues were found to have resulted from incorrect coding and billing for bundled services separately.
Within the scope of incorrect coding, providers were found to be submitting improper billing related to ventilator support hours, which begin with intubation and end when the tube is removed or the patient is transferred or discharged. Additionally, inpatient claims were found to be submitted with unrelated principal diagnosis and procedure codes.
The most common error associated with billing was claiming separate payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), leading to suppliers inappropriately receiving separate DMEPOS payment when the beneficiary was in a covered inpatient stay.
The average RAC audit recovered $398 on an outpatient claim and $5,200 on an inpatient claim, according to Fierce Health Finance.
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