CMS Reports More Appeals in RAC Demo

Providers appealed more improper payment decisions made by its
Recovery Audit Contractors than CMS first reported, the agency said
last week. Of the more than 525,000 overpayment determinations made
by the RACs between 2005 and 2008, providers appealed more than
118,000, or 22.5 percent.

Of the decisions that were appealed, CMS said, 34 percent were
overturned in providers’ favor. In its initial report in July, the
agency said providers had appealed only 14 percent of the
determinations.

In the three-year RAC demonstration, which involved six states,
as of March the audits had identified more than $1 billion in
improper payments, including $38 million in underpayments to
providers. Those results propelled CMS to name permanent RACs, with
plans to roll out the post-payment reviews to all 50 states.

For more on the RAC program, see CMS Launches Anti-Fraud Demo; Industry
Asks, What Took You So Long?, HomeCare Monday, Nov.
17, 2008.