logo

Category : Press Release

FY2016 RAC Report to Congress: Constraints on the RAC program cause Medicare improper payment recoveries to stall

FY2016 RAC Report to Congress: Constraints on the RAC program cause Medicare  improper payment recoveries to stall Washington, D.C. – September 19, 2018 – The Centers for Medicare and Medicaid Services (CMS) have released the fiscal year 2016 Medicare Fee-For-Service (FFS) Recovery Audit Contractor (RAC) Program annual report to Congress. The RAC Program was mandated by Congress as a safeguard to review provider and supplier Medicare claims on a post-payment basis to identify and correct improper payments, ensuring that program […]

AHA recommendations for Medicare appeals ignore existing integrity program reforms

AHA recommendations for Medicare appeals ignore existing integrity program reforms Washington, D.C. (July 10, 2018) – 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 regarding how to address the 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 CMS rules, they also clearly demonstrate that […]

Medicare Trustees: Part A program will be insolvent three years earlier

Medicare Trustees: Part A program will be insolvent three years earlier   Curtailment of Medicare integrity programs contributes to program insolvency Washington, D.C. (June 6, 2018) – A new Medicare Trustees report predicts that the inpatient Trust Fund will soon begin paying out more in benefits than it collects in payroll taxes from American paychecks. As a result, Medicare Part A will only be able to manage this gap until 2026, after that, the program will have to scale back […]

Prepayment Reviews Can Improve Quality of Care in the Medicare FFS Program

New CMS Final Rule Implements Prepay Reviews in Medicare Advantage & Part D Programs Washington, D.C. – In April, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-4182-F) that updates the Medicare Advantage (MA) and prescription drug benefit programs (Part D), providing new tools to improve quality of care. One of the notable program changes implemented within the new rule is the addition of more proactive program integrity efforts – prepayment claim reviews. Prepayment reviews allow […]

Advocacy Group Urges HHS Secretary to Reduce Medicare Waste to Bolster the Budget

Washington, D.C. – Today, the Council for Medicare Integrity (CMI) sent a letter to Department of Health & Human Services (HHS) Secretary Alex Azar asking for expanded efforts to reduce improper billing within Medicare to decrease the need for planned program cuts. The letter praises the Secretary’s past successes with compliance efforts and his commitment to standards of excellence in government management while urging the application of those important ideals to bolster program integrity efforts that protect Medicare resources. “Today, […]

Low Volume Medicare Providers Get “Free Pass” From Auditing

Washington, D.C. – The Centers for Medicare & Medicaid Services (CMS) implemented new additional document request (ADR) limits last year that restrict Medicare recovery auditors to review no more than 0.5 percent of a provider’s total number of Medicare claims. The new ADR policy renders 99.5 percent of Medicare claims off limits from review for billing accuracy and has produced another side effect – low volume providers are now mathematically exempt from audits entirely. For example, any Medicare provider that […]

Medicare Trustees: Part A Program Insolvent by 2029

   Increased Focus on Reducing Improper Payments Can Extend the Life of the Medicare Program Washington, D.C. – A new Medicare Trustees report today predicts that the Medicare inpatient Trust Fund will only be fully funded until 2029. After that, Medicare Part A will only have enough to fund 88 percent of what’s covered today. The report goes on to warn lawmakers and the executive branch that they must “work closely and with a sense of urgency” to ensure the […]

Advocacy Group Urges HHS Secretary to Prioritize Reduction of Medicare Improper Payments

Washington, D.C. – Today, The Council for Medicare Integrity (CMI) sent a letter to Department of Health & Human Services (HHS) Secretary Tom Price asking for expanded efforts to reduce improper payments within the Medicare program. Last week, the Secretary testified before the Senate Finance Committee stating, “we are absolutely committed to program integrity.” The letter urges the Secretary to bolster program integrity efforts that protect Medicare resources and discusses concerns for the financial future of the Medicare program. “With Medicare […]

U.S. Comptroller General Reiterates GAO Recommendation That Medicare Add RAC Prepayment Reviews

Says Medicare is missing the opportunity to protect program solvency. Washington, D.C. – Recently, while testifying before the House Budget Committee regarding the current scale of government improper payments, the U.S. Comptroller General Gene Dodaro reiterated recommendations that CMS should implement a permanent Recovery Audit Contractor Prepayment Review Program. The Comptroller General said: “We recommended that CMS seek legislative authority to allow RAs to conduct prepayment claim reviews. HHS did not concur with this recommendation, stating that CMS has implemented […]

CMI Urges Congress to Mandate Medicare RAC Pre-Pay Claim Reviews

Leveraging expertise of recovery auditors could prevent billions lost to improper billing Washington, D.C. – Today, the Council for Medicare Integrity (CMI) asked Members of Congress to champion the authorization of a prepayment Recovery Audit Contractor (RAC) Program to review Medicare Fee-For-Service (FFS) claims before they are paid to identify errors and prevent tens of billions in improper payments from draining from the program each year. Medicare loses more money to improper payments than any other program government-wide. An improper […]