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Category : News Coverage

If we want to cut Medicare spending, let’s stop spending billions on improper payments

Paul Ryan recently shared that this year Congressional Republicans will focus on making significant cuts to America’s entitlement programs in an effort to reduce our nation’s deficit. The main focus of the reforms under discussion are cuts that serve to rein in Medicare spending. Interestingly, while on the campaign trail, President Trump passionately promised the American people that there would be no cuts to the Medicare, Medicaid or Social Security programs on his watch. So, is it at all possible for Congressional Republicans to […]

Medicare’s hospital audit regime

Medicare paid hospitals more than $180 billion in 2016, and the feds continue to conduct aggressive audits that claw back money based on inappropriate billing, Axios’ Bob Herman reports. The latest target: the University of Michigan Health System. HHS’ inspector general says UMHS has to forfeit $6.2 million after it found erroneous billing patterns with the system’s inpatient rehab claims, among other medical claims. UMHS disagreed with portions of the federal audit. Other hospital systems have been hit with even bigger clawbacks: […]

HHS OIG: University of Michigan Health System overbills Medicare by $6.2 million

The CMS overpaid the University of Michigan Health System $6.2 million and it should refund the federal government, according to HHS’ Office of Inspector General. The agency reviewed claims from 2014 and 2015 and found that the hospital did not fully comply with Medicare billing requirements for 73 claims that contained errors, resulting in overpayments. The health system did not have adequate controls to prevent the incorrect billing of Medicare claims, according to the OIG. The health system disagreed with some […]

Wasteful Medicare spending increases beneficiary out-of-pocket costs

Currently 56 million Americans rely on Medicare for healthcare coverage that provides financial protection during their senior years. Unfortunately, most are unaware that within the Medicare program there’s no ceiling on the amount of out-of-pocket costs a beneficiary could be expected to pay for covered services. According to a recent report from the Commonwealth Fund, more than a quarter of all Medicare beneficiaries — 15 million people — spend a staggering 20 percent or more of their income on premiums plus medical care. […]

Loophole allows low volume Medicare providers exemption from auditing

In May 2016, the Centers for Medicare & Medicaid Services announced new additional documentation request (ADR) limitsfor Medicare Recovery Audit Contractors (RACs) that review claims to identify and recover improper payments. The new policy reduced the annual ADR limit so auditors can review just 0.5 percent of a provider’s total number of paid Medicare claims. However, after three 45-day billing periods, CMS would then review provider billing accuracy rates and adjust each provider’s ADR limit higher or lower based on their […]

Viewpoint: Some providers receive a ‘free pass’ from auditing Medicare claims

Low-volume Medicare providers escape from having claims reviewed for accuracy under new additional documentation request limits for recovery audits, according to Kristin Walter, an opinion contributor to The Hill. Ms. Walter, spokesperson for The Council for Medicare Integrity, outlines the new policy and her viewpoint in a recent article. CMS in May 2016 revealed new ADR limits for the Medicare Fee-For-Service Recovery Audit Program. The policy calls for an annual baseline ADR limit of 0.5 percent of the provider’s paid Medicare claims from […]

Low volume Medicare providers are getting a ‘free pass’ from auditing

Back in May, 2016, the Centers for Medicare & Medicaid Services (CMS) announced new additional documentation request (ADR) limits for Medicare Recovery Audits that review claims to identify and recover improper payments. The new policy reduced the annual ADR limit so auditors can review just 0.5 percent of a provider’s total number of paid Medicare claims with an additional twist. The twist is CMS would review provider billing accuracy rates over three 45-day periods and adjust each provider’s ADR limit higher or […]

Improper Pay Rate Dips Below 10% As Home Health, IRF Rates Improve

The drop in CMS’ improper pay rate for fee-for-service Medicare was driven by a reduction in improper pay to home health agencies and inpatient rehabilitation facilities — though CMS says home health companies and IRFs, along with nursing homes, were the major contributors to the 9.5 percent improper pay rate in fiscal 2017, and the HHS Office of Inspector General said program integrity is still a top management challenge for the agency. Medicare’s improper pay rate has not been below […]

OIG: Rush University Medical Center overbilled Medicare by $10.2M

Rush University Medical Center in Chicago failed to comply with Medicare billing requirements for 57 of 120 inpatient and outpatient claims reviewed by HHS’ Office of Inspector General, according to a recent OIG report. The 57 claims that did not comply with Medicare billing requirements resulted in the hospital receiving $814,150 in combined overpayments during 2014 and 2015, according to the OIG. Extrapolating from the sample results, the OIG estimated Rush University Medical Center received approximately $10.2 million in overpayments from […]

No, RAC audits do not impact patient care

Many myths are tough to dispel because they are so often repeated. No, cold weather does not give you the cold or flu. A shark cannot smell a single drop of blood from miles away. Chewing gum does not stay in your stomach for seven years. And, be careful because lightning can, in fact, strike the same place twice. Despite being thoroughly debunked; some still believe myths like these are true. The same goes for myths about Medicare Recovery Audit […]