Tag Archives: HDI

AUDITED CLAIMS PER PHYSICIAN | AMOUNT RECOVERED PER PHYSICIAN

The Recovery Audit program from CMS used four companies in FY 2012.   These are HDI, CGI, Performant, and Connolly.   These companies each are responsible for a specific part of the United States.

CMS_RECOVERY_RATES.001

(Source: Barraclough analysis.)

One would assume that the audit patterns would be roughly similar, but they are not.

If we use as a basis the total number of active physicians practicing in each region(*) and compare this to the activities of the Recovery Auditors, then an uneven pattern emerges.

RAC_regions.001NOTE: (*) Source: The Henry J. Kaiser Family Foundation

RECOVERY AUDIT CONTRACTOR HDI AUDITS THE LEAST AND RECOVERS THE MOST

The Recovery Audit program from CMS used four companies in FY 2012.   These are HDICGIPerformant, and Connolly.   These companies each are responsible for a specific part of the United States.

If we use as a basis the total number of active physicians practicing in each region(*) and compare this to the activities of the Recovery Auditors, then an uneven pattern emerges.

One would assume that the audit patterns would be roughly similar, but they are not.

CMS_RECOVERY_EFFICIENCY.001

(Source: Barraclough analysis.)

It appears that HDI audits the least number of claims per physician, but in exchange recovers the greatest amount of claw backs.

RAC_regions.001NOTE: (*) Source: The Henry J. Kaiser Family Foundation

CMS RECOVERY AUDIT CONTRACTOR – RESTORED UNDERPAYMENTS LOWEST IN NORTH-EAST

It appears that if you were located in the Western Region of the United States, your chances of having a claim paid is more than twice as high as if you are in the North East, which has the lowest return rate for claims that were not paid but should have been.

Here is the data according to the Recovery Auditor:

CMS_CLAIMS.001

According to the most recent report concerning the Recovery Audit Program from CMS regarding its auditing program, a small number of underpayments were restored.

There are four Regions of Recovery Auditors in FY 2012:

RAC_regions.001