The Centers for Medicare and Medicaid Services (CMS) recently released a report to Congress detailing the actions of Recovery Audit Contractors (RACs). Mandated by the PPACA, the report pinpointed $92 million in improper Medicare payments during fiscal year (FY) 2010 that were indentified and corrected by RACs.
According to CMS, this number included $75 million in Medicare overpayments that were recovered by RACs and $17 million in underpayments that were returned to providers. Of the $75 million in recovered overpayments, $41 million were from inpatient claims, $19 million were from durable medical equipment claims, $9 million were from outpatient claims, $5 million were from physician claims and $900,000 were from skilled nursing facility, home health and other claims.
The RAC program – which is divided into four geographic regions – corrected 192,000 claims in FY 2010, thanks to changes to the program that allowed for the processing of larger numbers of claims.
The PPACA also expanded the RAC program into Medicare Parts C and D, and into the Medicaid program. CMS published a final rule on this expansion in the Federal Register on September 16, with an implementation date of January 1, 2012.