Recovery Auditor Improper Payments Ratchet Up

With the close of the fiscal year quarter, the Centers for Medicare & Medicaid Services has again released statistics for the amount of overpayments and underpayments. The latest report shows that the trend continues to point upward, as CMS has once again corrected more improper payments than the previous quarter, this time to the tune of $701.3 million.

In the latest quarter, CMS collected $657.2 million in overpayments and $44.1 million in underpayments. In the previous quarter, CMS identified $588.4 million in overpayments and $61.5 million in underpayments for a total of $649.9 million in corrections. Since October 2009, CMS has corrected a grand total of $2.8 billion in improperly billed Medicare claims.

The upward trend continues to show that providers must get their billing and documentation shored up on the front end, says Elizabeth Lamkin, MHA, CEO, Pace Healthcare Consulting, LLC, in Hilton Head, S.C.

"Put the bulk of your care management staff and resources on the front end with bed status determination [inpatient or observation], use second-level physician advisor reviews, and have a clinical documentation improvement specialist reviewing concurrently," she says.