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Tag : Improper payments

Auditors Recouped $214M in Medicare Improper Payments in 2016

Auditors Recouped $214M in Medicare Improper Payments in 2016 Medicare Recovery Audit Contractors (RACs) corrected 7.5 percent more claims in 2016, resulting in greater recoupment of Medicare improper payments. September 28, 2018 – Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned a net of $214.09 million to the Medicare Trust Fund after accounting for administrative and operating […]

Report to Congress finds $474M in improper payments from fee-for-service Medicare

Report to Congress finds $474M in improper payments from fee-for-service Medicare A tweak to the federal government’s methods of auditing healthcare payment programs has scaled back the number of discovered improper payments. That’s according to the latest report to Congress on 2016 work done by Recovery Audit Contractors in fee-for-service Medicare. The RAC program was put in place to review provider payments, after they’ve been issued, to root out improper payments. The report noted that in fiscal 2016, RACs found improper payments […]

Medicare auditors saved program $214M in FY 2016 and 7 other things to know

Medicare auditors saved program $214M in FY 2016 and 7 other things to know The Medicare Recovery Audit Contractor program corrected $404.46 million in overpayments and $69.46 million in underpayments in fiscal year 2016, according to CMS’ report to Congress. Eight things to know about the 2016 results: 1. In 2016, recovery audit contractors corrected $473.92 million in improper payments, including overpayments collected and underpayments repaid to healthcare providers. That’s up 7.5 percent from $440.69 million the year prior. 2. Sixty-three percent […]

FY2016 RAC Report to Congress: Constraints on the RAC program cause Medicare improper payment recoveries to stall

FY2016 RAC Report to Congress: Constraints on the RAC program cause Medicare  improper payment recoveries to stall Washington, D.C. – September 19, 2018 – The Centers for Medicare and Medicaid Services (CMS) have released the fiscal year 2016 Medicare Fee-For-Service (FFS) Recovery Audit Contractor (RAC) Program annual report to Congress. The RAC Program was mandated by Congress as a safeguard to review provider and supplier Medicare claims on a post-payment basis to identify and correct improper payments, ensuring that program […]

Amid dire economic reports, wasteful Medicare spending must stop

Amid dire economic reports, wasteful Medicare spending must stop According to the latest economic outlook report from the Congressional Budget Office, the 2018 federal deficit will total $804 billion – $139 billion more than the $665 billion shortfall recorded in 2017 – and is expected to grow substantially over the next several years. What’s causing such rapid increases to the deficit? Mandatory federal spending continues to rise predominantly due to growth in Social Security and Medicare outlays. These increases are driven by the combination of […]

Congress needs to do something about improper Medicare billing practices

Congress needs to do something about improper Medicare billing practices The Medicare Trustees have released a new report predicting that  the inpatient Trust Fund will soon begin paying out more in benefits than it collects in payroll taxes from American paychecks. Medicare Part A will only be able to manage this financial gap until 2026, after that, the program will have no choice but to scale back inpatient hospital coverage — adding more out-of-pocket burden on seniors. The trustees report calls on Congress […]

Loophole allows low volume Medicare providers exemption from auditing

In May 2016, the Centers for Medicare & Medicaid Services announced new additional documentation request (ADR) limitsfor Medicare Recovery Audit Contractors (RACs) that review claims to identify and recover improper payments. The new policy reduced the annual ADR limit so auditors can review just 0.5 percent of a provider’s total number of paid Medicare claims. However, after three 45-day billing periods, CMS would then review provider billing accuracy rates and adjust each provider’s ADR limit higher or lower based on their […]

Viewpoint: Some providers receive a ‘free pass’ from auditing Medicare claims

Low-volume Medicare providers escape from having claims reviewed for accuracy under new additional documentation request limits for recovery audits, according to Kristin Walter, an opinion contributor to The Hill. Ms. Walter, spokesperson for The Council for Medicare Integrity, outlines the new policy and her viewpoint in a recent article. CMS in May 2016 revealed new ADR limits for the Medicare Fee-For-Service Recovery Audit Program. The policy calls for an annual baseline ADR limit of 0.5 percent of the provider’s paid Medicare claims from […]

Low volume Medicare providers are getting a ‘free pass’ from auditing

Back in May, 2016, the Centers for Medicare & Medicaid Services (CMS) announced new additional documentation request (ADR) limits for Medicare Recovery Audits that review claims to identify and recover improper payments. The new policy reduced the annual ADR limit so auditors can review just 0.5 percent of a provider’s total number of paid Medicare claims with an additional twist. The twist is CMS would review provider billing accuracy rates over three 45-day periods and adjust each provider’s ADR limit higher or […]

McKnights

When does a review of 0.5% make sense?

Would you feel safe flying if airlines only inspected 0.5% of their fleet of planes? What about if smoke detectors for your home were rolling off the assembly line with only 0.5% being tested to ensure that they worked to sense a fire emergency? That’s what we’re facing with payment accuracy in Medicare these days. The Centers for Medicare & Medicaid Services have drastically scaled back review of the claims providers submit to the Medicare Fee for Service program for […]