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Category : News Coverage

Congress needs to give CMS the authority to conduct prepayment reviews

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule (CMS-4182-F) that updates the Medicare Advantage (MA) and Medicare prescription drug benefit program (Part D). This will provide incentives to encourage fraud reduction activities defined as the prevention, identification and recovery of fraud. CMS notes that reducing fraud can improve patient safety, deter the use of medically unnecessary services and can lead to higher levels of health-care quality. We agree. We also support CMS’ assertion that fraud reduction activities are particularly […]

Council for Medicare Integrity urges CMS to implement prepayment claim reviews in fee-for-service program

The Council for Medicare Integrity, a nonprofit advocacy organization, is calling on CMS to implement prepayment claim reviews within Medicare Parts A and B. CMS included such reviews for Medicare Advantage and Part D in its 2019 Medicare Inpatient Prospective Payment System proposed rule filed April 24. The rule, which applies to about 3,300 acute care hospitals and 420 long-term care hospitals, incentivizes managed care organizations to review claims prior to payment for billing accuracy, rather than relying on “pay and chase” efforts to combat […]

Medicare should review provider claims for accuracy before they are paid

Medicare has one of the highest rates of wasteful spending government-wide, losing more than $200 billion over the past five years to provider billing errors. Keep in mind that number does not include fraud, which is accounted for separately. That $200 billion is directly attributed to very preventable billing errors and a lack of compliance with Medicare billing rules. The fact that the loss of approximately $40 billion in tax dollars each year is tolerated is mind blowing enough, but when you […]

District Court Again Asks Hospitals To Propose Solution To Appeals Backlog

The D.C. District Court told hospitals to come up with proposals by June 22 to clear out the backlog of Medicare appeals and to explain why current procedures are insufficient, and the government will have until July 6 to respond to those proposals, according to a recent court order. The American Hospital Association sued HHS over the appeals backlog because decisions at the Administrative Law Judge level were not turned around within 90 days as required by law. After gathering […]

McKnights

Congress should require more Medicare claim auditing — before and after payment

At the beginning of the year, Congressional Republicans shared that they will focus on making broad 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. Unfortunately, the Medicare program has been facing solvency concerns stemming from increasing healthcare costs and beneficiary populations. Medicare trustees report that without changes to program spending, Medicare Part A will start paying out more […]

RACs Ask Azar To Let Them Review Additional Claims

The Council for Medicare Integrity, which represents Recovery Auditors, is asking HHS Secretary Alex Azar to let RACs audit more claims and to push Congress for a permanent RAC prepayment review program. The RACs say the audits “have absolutely no direct impact on the Medicare providers” but past provider complaints about audits led to program reforms. In a March 6 letter to Azar, the council asks his “support of the Medicare integrity programs put in place by Congress to prevent […]

McKnights

Advocacy group calls on CMS to increase Medicare audits, expand review criteria

The Council for Medicare Integrity this week asked Department of Health & Human Services Secretary Alex Azar to expand efforts to reduce improper Medicare billing as heading off some planned program cuts. While praising the secretary’s previous compliance efforts, a letter from the Council urges him to bolster program integrity efforts at the Centers for Medicare & Medicaid Services and save money by expanding the use of existing tools. “Since Congress mandated the RAC Program, more than $10 billion in improper payments […]

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 […]