By Deborah J. Juneau

CMS released 2011 recovery results for the Recovery Audit Contractor (RAC) Program. The 2011 figures reflect a significant increase over the amounts recovered or returned to providers in 2010. Through four quarters (October, 2010 through September, 2011), RAC contractors recovered a total of $797.4 million in overpayments, with $141.9 million in underpayments returned to providers. The recovery amounts increased with each quarter of the fiscal year, from $82.9 million in the first quarter to $277.1 million in the last quarter.

By comparison, the total overpayments collected in fiscal year 2010 were $75.4 million, with $16.9 million in underpayments returned to providers. The 2011 figures represent a 90.5% increase over the overpayment amounts recovered in 2010. Similarly, the 2011 figures represent an 88.1% increase over the underpayment amounts returned to providers in 2010.

One of the top issues identified by the RAC contractor for Region C, which encompasses Louisiana, was medical documentation to support acute inpatient admissions related to neurological disorders. Another top issue for Region C was billing for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provided during an in-patient hospital admission, an issue identified by the RAC contractor as billing for bundled services separately.

Beginning January 1, 2012, CMS will launch a new three year Recovery Audit Prepayment Demonstration project. The new demonstration project will allow RAC contractors to conduct pre-payment claims reviews, in addition to post-payment claims reviews, so that errors are detected before claims are paid and monies must be recovered.