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If you have never heard of the Recovery Audit Contractor (RAC) program, it’s only a matter of time. A little bit of history is in order here. Between 2005 and 2008, a demonstration program that used Recovery Auditors identified Medicare overpayments, as well as underpayments, to both providers and suppliers of health care in random states. The result was that a whopping $900 million in overpayments was returned to the Medicare Trust Fund, while close to $38 million in underpayments was given to health care providers.
Obviously, this program was a tremendous success for the Centers for Medicare and Medicaid Services (CMS), and it has since taken off in all 50 states. And, you guessed it, it remains a great boon for the Medicare Trust Fund.
In fiscal year 2010, $75.4 million in overpayments was collected, and $16.9 million returned, and in fiscal year 2013, $2.2 billion in overpayments was collected, while $370 million was returned. Since the program’s inception, there has been $5.7 billion in total corrections, of which, $5.4 billion was collected from overpayments.
Surprised? I think most of us, and our hospitals, could benefit by hospitalists learning more about the RAC and what we could do to guard against a successful audit and penalty. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data stats for discharges and services that are vulnerable. Pepperresources.org was developed by TMF Health Quality Institute, which was contracted by the CMS.
PEPPER has many uses, but one of the most useful for hospitals is to compare its claims data over time to identify concerning trends, such as significant changes in billing practices, increasing length of stay, and over- or undercoding. In 2013, practicing good medicine just isn’t enough. You have to make sure you are documenting appropriately to justify the codes you bill. Outliers beware!
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.
If you have never heard of the Recovery Audit Contractor (RAC) program, it’s only a matter of time. A little bit of history is in order here. Between 2005 and 2008, a demonstration program that used Recovery Auditors identified Medicare overpayments, as well as underpayments, to both providers and suppliers of health care in random states. The result was that a whopping $900 million in overpayments was returned to the Medicare Trust Fund, while close to $38 million in underpayments was given to health care providers.
Obviously, this program was a tremendous success for the Centers for Medicare and Medicaid Services (CMS), and it has since taken off in all 50 states. And, you guessed it, it remains a great boon for the Medicare Trust Fund.
In fiscal year 2010, $75.4 million in overpayments was collected, and $16.9 million returned, and in fiscal year 2013, $2.2 billion in overpayments was collected, while $370 million was returned. Since the program’s inception, there has been $5.7 billion in total corrections, of which, $5.4 billion was collected from overpayments.
Surprised? I think most of us, and our hospitals, could benefit by hospitalists learning more about the RAC and what we could do to guard against a successful audit and penalty. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data stats for discharges and services that are vulnerable. Pepperresources.org was developed by TMF Health Quality Institute, which was contracted by the CMS.
PEPPER has many uses, but one of the most useful for hospitals is to compare its claims data over time to identify concerning trends, such as significant changes in billing practices, increasing length of stay, and over- or undercoding. In 2013, practicing good medicine just isn’t enough. You have to make sure you are documenting appropriately to justify the codes you bill. Outliers beware!
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.
If you have never heard of the Recovery Audit Contractor (RAC) program, it’s only a matter of time. A little bit of history is in order here. Between 2005 and 2008, a demonstration program that used Recovery Auditors identified Medicare overpayments, as well as underpayments, to both providers and suppliers of health care in random states. The result was that a whopping $900 million in overpayments was returned to the Medicare Trust Fund, while close to $38 million in underpayments was given to health care providers.
Obviously, this program was a tremendous success for the Centers for Medicare and Medicaid Services (CMS), and it has since taken off in all 50 states. And, you guessed it, it remains a great boon for the Medicare Trust Fund.
In fiscal year 2010, $75.4 million in overpayments was collected, and $16.9 million returned, and in fiscal year 2013, $2.2 billion in overpayments was collected, while $370 million was returned. Since the program’s inception, there has been $5.7 billion in total corrections, of which, $5.4 billion was collected from overpayments.
Surprised? I think most of us, and our hospitals, could benefit by hospitalists learning more about the RAC and what we could do to guard against a successful audit and penalty. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) provides provider-specific Medicare data stats for discharges and services that are vulnerable. Pepperresources.org was developed by TMF Health Quality Institute, which was contracted by the CMS.
PEPPER has many uses, but one of the most useful for hospitals is to compare its claims data over time to identify concerning trends, such as significant changes in billing practices, increasing length of stay, and over- or undercoding. In 2013, practicing good medicine just isn’t enough. You have to make sure you are documenting appropriately to justify the codes you bill. Outliers beware!
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS.
