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Tag : Improper payments

Viewpoint: Some providers receive a ‘free pass’ from auditing Medicare claims

Low-volume Medicare providers escape from having claims reviewed for accuracy under new additional documentation request limits for recovery audits, according to Kristin Walter, an opinion contributor to The Hill. Ms. Walter, spokesperson for The Council for Medicare Integrity, outlines the new policy and her viewpoint in a recent article. CMS in May 2016 revealed new ADR limits for the Medicare Fee-For-Service Recovery Audit Program. The policy calls for an annual baseline ADR limit of 0.5 percent of the provider’s paid Medicare claims from […]

Low volume Medicare providers are getting a ‘free pass’ from auditing

Back in May, 2016, the Centers for Medicare & Medicaid Services (CMS) announced new additional documentation request (ADR) limits for Medicare Recovery Audits that review claims to identify and recover improper payments. The new policy reduced the annual ADR limit so auditors can review just 0.5 percent of a provider’s total number of paid Medicare claims with an additional twist. The twist is CMS would review provider billing accuracy rates over three 45-day periods and adjust each provider’s ADR limit higher or […]

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 […]

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 […]