Over Paid?-RACs take notice

The Recovery Audit Contractors continue to find new targets for review and recoup lost dollars for CMS. CMS must provide approval to the RAC auditors in order for them to investigate a particular issue. Once the RAC receives approval, they post the “target” or “issue” to their website as a way to notify you of what they are investigating.

A recent issue posted on the Connolly RAC website indicates that they will be investigating a review of provider services they believe to be overpaid by Medicare due to a fee schedule error. If the Medicare contractor pays you using the wrong fee schedule, you may be paid too much. On occasion, the Medicare fee schedule is adjusted due to a RVU error or a regulatory change. If the Medicare contractor does not pay your claim based on the appropriate fee schedule for a particular service or supply, you are responsible for recognizing the overpayment and making a prompt refund.

RAC auditors expect to analyze and recoup dollars that were overpaid due to a fee schedule issue. Of particular concern is the repetitive nature of a possible overpayment. If the MAC applies the wrong fee schedule to a service you provide often, and it is not caught early, the potential overpayment could be large.

Check your contractor website frequently to see notices regarding fee schedule changes. Make sure that your staff recognizes overpayments and responds quickly.