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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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]