• CMS Releases March 2011 Report On National RAC Program
  • May 9, 2011 | Author: Susan Banks
  • Law Firm: King & Spalding LLP - Washington Office
  • CMS has released a March 2011 report on the national Medicare fee-for-service Recovery Audit Contractor (RAC) Program.  Since the nationwide permanent RAC program began on October 1, 2009, $313.2 million in overpayments have been returned to Medicare and $52.6 million in underpayments have been paid to providers.  The 3-year demonstration program, which ran from March 2005 through March 2008, reported total corrections in the amount of $992.7 million for overpayments and $37.8 million for underpayments.

    Top overpayment issues identified by RACs include incorrect coding and errors involving separate billing of bundled services.  The RACs for the various regions specifically cited the following issues:

    Region A, Diversified Collection Services

    Ventilator Support of 96+ hours - Ventilation hours begin with the intubation of the patient (or time of admittance if the patient is admitted while on mechanical ventilation) and continue until the endotracheal tube is removed, the patient is discharged/transferred, or the ventilation is discontinued after a weaning period. Providers are improperly adding the number of ventilator hours resulting in higher reimbursement.

    Region B, CGI, Inc.

    Extensive Operating Room Procedure Unrelated to Principal Diagnosis - The principal diagnosis and principal procedure codes for an inpatient claim should be related. Errors occur when providers bill an incorrect principal and/or secondary diagnosis that results in an incorrect Medicare Severity Diagnosis-Related Group assignment.

    Region C, Connolly, Inc., and Region D, HealthDataInsights

    Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Provided During an Inpatient Stay - Medicare does not make separate payment for DMEPOS when a beneficiary is in a covered inpatient stay. Suppliers are inappropriately receiving separate DMEPOS payment when the beneficiary is in a covered inpatient stay.