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Medicare Compliance & Reimbursement

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Published on Sat Nov 11, 2006

· The Recovery Audit Contractors (RACs) that the Centers for Medicare & Medicaid Services (CMS) is testing in New York, California and Florida recovered $303.5 million in improper payments in their first year -- including $17.9 million from physicians, according to a status report from CMS. The RACs found $10.5 million in underpayments, but these all came from hospitals, not physicians. Three quarters of overpayments (77 percent) came from hospitals. · Medicare may grant a physicians an extended repayment schedule (ERS) for overpayments if she qualifies as suffering from "hardship," meaning the overpayments account for 10 percent or more of the physician's total Medicare payments. Also, if a physician qualifies as suffering from "extreme hardship," according to a complex formula, then she can have a longer-term ERS, lasting up to 60 months, according to a proposed rule in the Nov. 27 Federal Register (Vol. 71, No.  227, pp. 68519-68524).
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