CMS Releases RAC Data: More Than 43% of Overpayment Appeals Returned in Favor of Providers

In June 2012 the Centers for Medicare and Medicaid Services (CMS) released Recovery Audit Program appeals data for fiscal year 2011. The report indicates that of the claim denials appealed, 43.4% were returned in the provider’s favor.

In fiscal year 2011, 903,372 claims were determined to be overpayments. Of those overpayments, 56,620 were appealed by the provider and 24,548 were returned in the provider’s favor.

The data shows that the type of claims overturned on appeal were more commonly automated claims, but far more money was overturned in complex claims. Nearly $30 million in overpayments was overturned on appeal in complex claim denials alone.

If you need help defending a RAC audit, or have questions about implementing an audit compliance plan, please contact an experienced healthcare attorney at Wachler & Associates at 248-544-0888.