decisionhealth Newsletters, Part B News - 2014 Issue 10 (October)
Part B providers have most success appealing RAC decisions at first level
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Article Overview
This article reviews Medicare Part B Recovery Audit Contractor activity using CMS fiscal year 2013 reporting. It focuses on appeal outcomes across multiple levels, the general pattern of overpayment versus underpayment corrections, and how different recovery auditors contributed to those results. The piece is relevant to billing, compliance, and appeals professionals who track Medicare audit trends and contractor performance.
Why This Topic Matters
Understanding appeal success rates and audit correction patterns helps providers and compliance teams assess audit risk, monitor Medicare enforcement trends, and evaluate the broader impact of RAC activity on Part B claims.
Article Sections
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Benchmark of the week
A brief headline-style summary of appeal outcomes for Part B providers is presented, with context for the broader Medicare audit discussion.
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RACs keep focus on overpayments in FY 2013
This section summarizes fiscal year 2013 recovery auditor activity and compares the distribution of claim corrections across major auditors using CMS reporting.
What You Will Learn
- How CMS reported appeal outcomes for Medicare Part B claims across multiple appeal levels
- What the article highlights about recovery auditor correction patterns in fiscal year 2013
- Which broad audit and compliance trends are emphasized for Part B providers
- How the article frames RAC activity in the context of overpayments and underpayments
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance officers
- Healthcare administrators
- Medicare appeals staff
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