Details of payments that were under, over
September 1, 2008 less than 1 minute read
Details of payments that were under, over
Recovery audit contractors (RACs) have returned $693.6 million to Medicare.
This number includes appeals overturned through March 27, 2008. However, some appeals are pending. Providers have 120 days to appeal from the date of the claim adjustment. As of March 27, 2008, providers had chosen to appeal 14% of the RAC decisions. Of all the RAC overpayment determinations, only 4.6% were overturned on appeal.
The breakdown of overpayments is:
- 40% were medically unnecessary, $391.3 million;
- 35% were incorrectly coded, $331.8 million;
- 8% were no/insufficient documentation, $74.3 million;
- 17% were other reasons, $160.2 million. Other reasons include basing claim payments on outdated fee schedules, or paying the provider twice because duplicate claims were submitted.
For hospital outpatient errors, the top error was excessive/multiple units (79% of errors). There was $6.5 million collected (less cases overturned on appeal) for medically unnecessary Neulasta. The collections involved 558 claims in New York and Florida.
By establishing strong internal controls, hospitals can use these findings to train coders, physicians, medical record staff, and others to help minimize future improper payments, according to the Centers for Medicare & Medicaid Services.
For hospital outpatient services, the underpayments included:
- Drug codes (incorrectly coded). $ 1.1 million refunded. 1,084 claims with underpayments. Location: New York.
- Oxaliplatin (incorrectly coded). $614,269 refunded. 346 claims with underpayments. Location: New York.
- Darbopoetin (incorrectly coded). $260,176 refunded. 726 claims with underpayments. Location: New York.
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