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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 […]

McKnights

When does a review of 0.5% make sense?

Would you feel safe flying if airlines only inspected 0.5% of their fleet of planes? What about if smoke detectors for your home were rolling off the assembly line with only 0.5% being tested to ensure that they worked to sense a fire emergency? That’s what we’re facing with payment accuracy in Medicare these days. The Centers for Medicare & Medicaid Services have drastically scaled back review of the claims providers submit to the Medicare Fee for Service program for […]

CMS Official Sidesteps Offer Of Tools To Combat Medicare Improper Pay

House Ways & Means Republicans asked CMS acting program integrity director Jonathan Morse what additional tools the agency might need to help bring down improper payment rates in Medicare — 11 percent for Medicare fee-for-service and about 10 percent for Medicare Advantage in fiscal 2016, according to the government’s payment accuracy website — but Morse did not ask for any additional authority, even though a representative from the Government Accountability Office suggested lawmakers could give CMS the authority to let […]

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 […]

Mount Sinai asked to return $41.9 million in Medicare overpayments

The Office of Inspector General at HHS said Wednesday that an audit of 2012 and 2013 claims revealed that Mount Sinai Hospital did not fully comply with Medicare billing requirements. The agency audited 261 claims and found that 110 resulted in overpayments totaling at least $41.9 million for the audit period. Mount Sinai in New York City is required to do its own investigation of the problem going back six years, and refund the federal government all overpayments within 60 […]

Becker’s Hospital Review: Private sector best practices can help save Medicare

Today, more than 55 million Americans rely on Medicare for health and financial security as they age. Unfortunately, current beneficiaries, along with those who expect to enroll in the future, are unaware that the healthcare program they have long counted on to support them as they age will look much different in just 10 years – and not for the better. Medicare Trustees report that at current high spending levels and with the expected influx of new beneficiaries, the program […]

McKnights

Warnings About Medicare’s Future Continue to Be Ignored

Guest Columns Warnings about Medicare’s future continue to be ignored The Government Accountability Office has released its 2017 “High Risk List,” which identifies federal agencies and programs vulnerable to fraud, waste, abuse and mismanagement. The list is published every two years at the start of a new Congress, raising the alarm about areas that greatly need attention and redirection. First designated as “high risk” back in 1990, Medicare has made the GAO list every year since due to “its size, […]

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 […]