By most accounts, 2014 was a tumultuous year for healthcare providers. The administrative law judges (ALJs) suspended the scheduling of hearings while the Centers for Medicare & Medicaid Services (CMS) suspended Recovery Auditor (RAC) audits due to contractual disagreements with the RACs themselves. Reversal rates on appeals skyrocketed and to help clear up the backlog, CMS offered a limited number of facility types performing limited services the opportunity to pay 68 percent of overpayments resulting from a CMS audit. A majority of practices opted out due to a number of reasons, particularly prominent of which being distrust of CMS’s promise to settle promptly.
With respect to analytics, I’ve seen in 2014 a pretty significant increase in the use of extrapolation, to the point where it is pretty much the rule now rather than the exception. And the “why” is pretty clear: it can generate huge amounts of cash for auditors with the same amount of effort required than that associated with a face-value analysis.