The Centers for Medicare & Medicaid Services (CMS) has issued its first annual Recovery Audit Contractors (RAC) report to Congress, as required by Section 6411(b) of the Affordable Care Act (ACA).
Fiscal year 2010 was the first year in which the Recovery Auditors began actively identifying and correcting improper payments under the National Recovery Audit program. Recovery Auditors began reviewing claims in October 2009. According to the report, Implementation of Recovery Auditing at the Centers for Medicare & Medicaid Services, in the past fiscal year, the Recovery Auditors identified and corrected $92.3 million in combined overpayments and underpayments, of which $12.8 million was attributed to claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
Eighty-two percent of all Recovery Audit program corrections were collected overpayments and 18 percent were identified underpayments that were refunded to providers.
The report states that the Recovery Audit program has identified several program vulnerabilities and has worked to prevent them from occurring in the future. Samples of top-identified issues regarding DMEPOS claims resulting in identified overpayments include:
- DMEPOS provided during a covered inpatient stay.
- Durable medical equipment (DME) provided with the date of service after the patient’s death.
- Prosthetic bundling.
