Recovery Audit Contractors

CMS announced on July 11 that the recovery audit contractor (RAC) pilot program obtained net Medicare recoveries of $693.6 million through March 2008. The three-year pilot has been implemented in California, Florida, New York, Arizona, Massachusetts, and South Carolina. Eighty-five percent of the recoveries were on inpatient hospital services.  Most of the improper payments were associated with duplicate billing and improper coding. Providers appealed 14% of the findings and 4.6% were reversed on appeal. Congress has asked GAO to review the results of the pilot and to recommend improvements prior to nationwide implementation.

 

Tom Entrikin

Tom Entrikin is a PCG manager and former Medicaid policy specialist with the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS).