RACs snatch back $1.8M

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Recovery Audit Contractors collected $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released in late September.

The amount was up significantly from the year earlier, when a pilot program identified about $8,000 in SNF overpayments. 

In fiscal 2013, the Region D auditor began “spans of care” reviews for SNF claims, the Centers for Medicare & Medicaid Services noted in its report. These reviews encompassed all claims for a given beneficiary from admission through discharge. Region D comprises 17 states stretching from the Midwest to the West Coast, including California.

The auditors also restored more than $19,500 in underpayments to SNFs last year, according to the report.

RACs collected $3.65 billion in overall Medicare overpayments, up from $2.3 billion in fiscal 2012, CMS reported. 

The American Coalition for Healthcare Claims Integrity touted the report, particularly the findings of an independent validation contractor. It found RAC determinations are accurate more than 95% of the time.

Providers have contested a huge number of RAC decisions, leading to a staggering appeals backlog. The government has paused the beleaguered program and pledged improvements.