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Category : News Coverage

Auditors Recouped $214M in Medicare Improper Payments in 2016

Auditors Recouped $214M in Medicare Improper Payments in 2016 Medicare Recovery Audit Contractors (RACs) corrected 7.5 percent more claims in 2016, resulting in greater recoupment of Medicare improper payments. September 28, 2018 – Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned a net of $214.09 million to the Medicare Trust Fund after accounting for administrative and operating […]

Report to Congress finds $474M in improper payments from fee-for-service Medicare

Report to Congress finds $474M in improper payments from fee-for-service Medicare A tweak to the federal government’s methods of auditing healthcare payment programs has scaled back the number of discovered improper payments. That’s according to the latest report to Congress on 2016 work done by Recovery Audit Contractors in fee-for-service Medicare. The RAC program was put in place to review provider payments, after they’ve been issued, to root out improper payments. The report noted that in fiscal 2016, RACs found improper payments […]

Medicare auditors saved program $214M in FY 2016 and 7 other things to know

Medicare auditors saved program $214M in FY 2016 and 7 other things to know The Medicare Recovery Audit Contractor program corrected $404.46 million in overpayments and $69.46 million in underpayments in fiscal year 2016, according to CMS’ report to Congress. Eight things to know about the 2016 results: 1. In 2016, recovery audit contractors corrected $473.92 million in improper payments, including overpayments collected and underpayments repaid to healthcare providers. That’s up 7.5 percent from $440.69 million the year prior. 2. Sixty-three percent […]

MEDICARE TO ELIMINATE APPEALS BACKLOG WITHIN 4 YEARS, HHS TELLS JUDGE

MEDICARE TO ELIMINATE APPEALS BACKLOG WITHIN 4 YEARS, HHS TELLS JUDGE For years the Health and Human Services Office of Medicare Hearings and Appeals (OMHA) has been unable to keep up with the number of cases it receives, leading to a mountainous backlog of pending appeals. That backlog shrank, however, by more than 30% in the past year, dropping from more than 650,000 pending appeals last year to less than 445,000 late last month, according to documents HHS filed Friday in […]

Private sector best practices can improve Medicare solvency

Private sector best practices can improve Medicare solvency Last week, the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma delivered a speech at the Commonwealth Club sharing that the agency has a long way to go to prevent Medicare waste, fraud and abuse. She went on to say that the agency must learn from the private sector how to be more fiscally efficient. Administrator Verma cited that the Medicare program only reviews three tenths of one percent of all claims […]

Verma: CMS Has A Long Way To Go To Improve Medicare Program Integrity

Verma: CMS Has A Long Way To Go To Improve Medicare Program Integrity CMS Administrator Seema Verma said the agency has a long way to go to prevent Medicare waste, fraud and abuse, and pointed to the small percentage of claims that Medicare reviews, though Center for Program Integrity Director Alec Alexander recently touted Medicare’s falling improper pay rate before a House Ways & Means panel. Some providers and one beneficiary advocate raised concerns that Verma’s remarks could indicate a […]

Viewpoint: AHA takes wrong approach in guidelines for addressing Medicare appeals

Viewpoint: AHA takes wrong approach in guidelines for addressing Medicare appeals The Council for Medicare Integrity has come out against the American Hospital Association’s recommendations for Medicare appeals. In a July 10 announcement, the nonprofit advocacy organization said the AHA’s recommendations are “unconscionable” given current integrity program reforms. The announcement was in response to a brief filed by the AHA June 22 after Judge James Boasberg with the U.S. District Court for the District of Columbia asked the association to provide input on how to reduce […]

AHA Medicare appeals reform recommendations miss the mark

AHA Medicare appeals reform recommendations miss the mark Last week, the American Hospital Association (AHA) filed a brief with the federal court in response to U.S. District Judge James Boasberg’s request for ideas to address the current Medicare appeals backlog. Instead of making substantive administrative recommendations to improve the Medicare appeals process, the AHA makes suggestions that are not only redundant based on existing Centers for Medicare and Medicaid Services (CMS) rules. It also clearly demonstrate that the AHA is more interested […]

Amid dire economic reports, wasteful Medicare spending must stop

Amid dire economic reports, wasteful Medicare spending must stop According to the latest economic outlook report from the Congressional Budget Office, the 2018 federal deficit will total $804 billion – $139 billion more than the $665 billion shortfall recorded in 2017 – and is expected to grow substantially over the next several years. What’s causing such rapid increases to the deficit? Mandatory federal spending continues to rise predominantly due to growth in Social Security and Medicare outlays. These increases are driven by the combination of […]

Congress needs to do something about improper Medicare billing practices

Congress needs to do something about improper Medicare billing practices The Medicare Trustees have released a new report predicting that  the inpatient Trust Fund will soon begin paying out more in benefits than it collects in payroll taxes from American paychecks. Medicare Part A will only be able to manage this financial gap until 2026, after that, the program will have no choice but to scale back inpatient hospital coverage — adding more out-of-pocket burden on seniors. The trustees report calls on Congress […]