Category : News Coverage

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 […]

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 […]


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 […]


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 […]