Aug 8, 2020

Medicare shortchanges Missouri the most

Published Oct 9, 2011, 10:55am
Medicare shortchanges Missouri the most, audit finds

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Medicare shortchanges Missouri the most, audit finds

The Medicare program owes Missouri providers more than $3 million in underpayments for the fiscal year that ended Sept. 23. 2010.

Missouri health care providers led the nation last year in getting shortchanged by the Medicare program, according to a new federal audit.

The Centers for Medicare and Medicaid Services last week issued the first annual report to Congress of the Recovery Audit Contractor (RAC) program, which identifies errors in Medicare reimbursements to hospitals, physician offices, medical suppliers, ambulance services, nursing homes and other providers.

It found that Missouri providers were owed a little more than $3 million in underpayments during the fiscal year that ended Sept. 30, 2010. That was the highest amount of any state or territory in the audit.

Missouri providers also returned $2.3 million in overpayments during fiscal year 2010.

Although specific reasons for the underpayments in Missouri were not discussed in the report, statistics for the 17-state region that includes Missouri showed the top errors in the region involved improper coding or problems when discharging patients to places other than their homes.

Medicare providers in Kansas, meanwhile, owed the program $1.3 million in overpayments while being reimbursed for $857,843 in underpayments.

Nationwide, the RAC program collected a total of $75 million in Medicare overpayments in fiscal year 2010 while paying back $16.9 million in underpayments.

Created in 2003, the RAC program is aimed at finding medical billing mistakes in the Medicare program. Four contracted companies, each covering a section of the country, review Medicare claims for mistakes or errors and contact the providers to pay back the difference.

After several years of pilot programs and fine-tuning the regulations, the program went live nationally in 2009.

Several area hospitals have complained that the cost to comply with the audit program, which includes appealing the contractors’ decisions, is more than they anticipated.

Although the RAC program audits payments for Medicare Part A and Part B, the report last week said plans are in place to begin reviewing payments for Part C (Medicare Advantage) and Part D (prescription drugs), as well as for Medicaid, in the near future.

The full report is available here.

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