CMS reports that, overall, the updated data indicate that of all the RAC overpayment determinations (525,133), only 7.6 percent (40,115) were overturned on appeals as of August 31, 2008. As has been widely reported here and elsewhere, RACs succeeded in correcting more than $1.03 billion of Medicare improper payments. Approximately 96 percent of these improper payments were overpayments collected from providers, while the remaining 4 percent were underpayments repaid to providers.

Provider Appeals of RAC-Initiated Overpayments:

Cumulative through 8/31/08, Claim RACs Only

Claims with overpayment determinations

Claims appealed by provider (any level)

Claims with appeal decisions favorable to providers

Percentage of appealed claims with a decision in provider’s favor

Percentage of claims overturned on appeal

525,133

118,051

40,115

34.0%

7.6%

 

Source: cms.hhs.gov/RAC/Downloads/AppealUpdatethrough83108ofRACEvalReport.pdf

 

CMS says it will continue to update this information on a regular basis until all appeals have completed the appeals system.

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