Error Rate Among Medicare Auditors High

Recovery Audit Contractors (RAC) have recovered more dollars in 2011 than they did in 2010 but this metric of success may overstate their value.

A Washington Post story from yesterday, November 14 2011, shows that Medicare auditors make overpayment determinations based on "inaccurate data".

RAC activity in 2011 was centered in the West and the Southern United States.

State	Overpayment
Florida	$7.1 million
California	$7.7 million
Washington	$5.3 million
Texas	$5.8 million

"The error rate in the Medicare RAC process is disturbingly high, especially since the cost of filing an appeal can be prohibitive," said AMA President Peter W. Carmel, MD.

"The AMA is working with CMS to improve this process and decrease the financial and administrative burden on physicians."

A 2010 Office of the Inspector General (OIG) report found that CMS...

"...did not sufficiently oversee the RACs during the demonstration project to ensure the vulnerabilities pursued by RACs were valid and that RACs made accurate improper payment determinations.

According to provider associations, this led to numerous appeals of inaccurate RAC determinations that were expensive and burdensome for providers."

Physical therapists can reduce their risk of a RAC audit, or any Medicare audit by following the seven components of the OIG Compliance Program for Individual and Small Group Physician Practices.

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