CMS Audit Program Stats

For those interested in reviewing statistics related to the CMS Recovery Audit Program, please check out this page.  Here you will find numerous updates to different CMS programs including the Auditing Program.  Two things I found particularly interesting on this page include the Recovery Program Audit Summary and the Audit Program Appeals Update.

The summary includes a breakdown of the audits conducted from October 2010 through June 2012.  The page is broken down into easy to read charts including over payments collected and underpayments returned.  In total, approximately 2.5 BILLION DOLLARS has been adjusted by the Audit Program.  In addition to the monetary summary, the page includes the top overpayment issues for each region.  (Cardiovascular Procedures (Medical Necessity) is the #1 overpayment issue in 3 out of the 4 regions.)

Much like the Audit Summary, the Appeals Update provides a simple, yet detailed summary tracking the outcomes of the auditing appeals process.  Skipping right to the important information, the percentage of claims overturned on appeal for all denials (2.7%) and the amount of money over turned ($37.9 million) suggests that the auditing companies are quite accurate with their review.

Sure, audits may be stressful but, on the other hand, there’s a chance you are owed money!