Medicare Audits Recover $162 Million So Far This Year
The Centers for Medicare & Medicaid Services (CMS) has collected $162 million in Medicare overpayments during the first quarter of 2011. According to a recent CMS report, the CMS Recovery Audit Program has recovered $313.2 million in Medicare overpayments since 2009, and over half of that amount was recouped during January through March of this year. According to the report, the top overpayment issues involved issues of incorrect coding and billing for bundled services separately.
CMS Recovery Auditors
Recovery Auditors are CMS contractors tasked with detecting and correcting past improper payments. The Recovery Audit Contractor, or RAC, is an independent entity that pursues the identification of Medicare claims that contain improper payments. The term “improper payments” includes incorrect payment amounts, incorrectly coded services, non-covered services and duplicate services. The CMS Recovery Audit Program was made permanent by the passage of the Tax Relief and Health Care Act of 2006, and it is active in all states, including Pennsylvania.
Recoupment
Medicare utilizes a process authorized by federal statute called recoupment to recover overpayments. Recoupment is defined as the recovery by Medicare of any outstanding Medicare debt by reducing present or future Medicare provider payments and applying the amount withheld to the indebtedness (42 C.F.R. 405.370).
How to Prevent Medicare Audits
Medicare post-payment reviews are extremely challenging for health care providers. As with any post-payment review, providers should take preventative action. Doctors should know whether they are submitting claims with improper payments, and they should be prepared to respond to RAC documentation requests. Additionally, providers should adopt a proactive stance with regard to compliance by implementing a health care compliance program for their practice.
Medicare Appeals
Health care providers can request an appeal through the formal Medicare appeals process. Successful appeals usually occur only after a diligent review of the medical records by experienced attorneys and health care professionals combined with careful attention to the details and available defenses at each stage of the process. Providers are strongly encouraged to seek the expertise of a health care attorney when faced with a Medicare audit or a review from an RAC. Learn more about Medicare appeals.
The Martin Law Firm is a health law firm located in Blue Bell, Montgomery County, PA. The Martin Law Firm represents health care providers for matters involving health care compliance, Medicare audits and appeals, insurance post-payment reviews and general business matters. Contact The Martin Law Firm to speak to an experienced health care attorney today.