Insights to Coding and Data Quality: CMS releases 3rd quarter RAC report

On July 14, 2011 the Centers for Medicare and Medicaid Services (CMS) released the third quarter Medicare Fee for Service National Recovery Audit Program report. Region D, that includes California, had the highest overpayments collected through the work of contractor Health Data Insights (HDI). The Recovery Audit Contractors corrected $592.5 million in payments from the Medicare Fee-for-Service program through June 30, 2011, or until the end of the third quarter of the 2011 fiscal year.

The report also provided information regarding the areas which had the most errors and for Region D it was surrounding medical necessity. The following is from the report: Minor Surgery and other treatment billed as inpatient: (Medical Necessity). When beneficiaries with known diagnoses enter a hospital for a specific minor surgical procedure or other treatment that is expected to keep them in the hospital for less than 24 hours, they are considered outpatient for coverage purposes regardless of the hour they presented to the hospital, whether a bed was used, and whether they remained in the hospital after midnight. Share this information with your RAC and Compliance Committee’s. Be prudent with your monitoring of national RAC trends and findings as this will help in being proactive and thorough. To access the above mentioned report go to: http://www.cms.gov/Recovery-Audit-Program/Downloads/FFSUpdate.pdf