RAC Recovery: What a Difference a Fiscal Year Makes

Recently, the Centers for Medicare and Medicaid Services (CMS) released FY 2011 numbers for the Recovery Audit Contractor (RAC) collections. Total corrections amounted to $939.4 million with $797.4 million in overpayments and $141.9 million in underpayments. (American Health Lawyers Association, Medicare RACs Recover $797 Million in Overpayments in FY 2011, CMS Reports (Dec. 2, 2011)).

Compared to FY 2010, $939.4 is staggering. In FY 2010, combined over and under payments amounted to $92.3 million. In October 2009, all four regional RACs began reviewing claims. (http://www.cms.gov/Recovery-Audit-Program/Downloads/FY2010ReportCongress.pdf). These numbers will only increase as RAC expands to Medicaid in January 2012.

Therefore, providers should assess their clinical documentation. And, consider implementing a physician-to-physician clinical documentation improvement program to ensure that physicians are educated on appropriate documentation, and appreciate the liability associated with RAC audits.

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