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Tag : #Medicare #RAC #improperpayments

CMS Touts Less Improper Pay Across Programs, Particularly Medicare

CMS Touts Less Improper Pay Across Programs, Particularly Medicare CMS said the most recent improper pay rates show that, for the first time since the data has been reported, improper payment rates went down in Medicare fee-for-service, Medicare Advantage, Medicaid and the Children’s Health Insurance Program, and the fiscal 2018 Medicare fee-for-service improper pay rate is at the lowest since the 2010 rate. However, many of the same areas — home health, nursing homes and inpatient rehabilitation facilities — are […]

Medicare prepayment reviews could save billions lost to billing errors, advocacy group says

Medicare prepayment reviews could save billions lost to billing errors, advocacy group says The improper payment rate for Medicare fee-for-service fell from 9.51 percent in fiscal year 2017 to 8.12 percent in fiscal year 2018, the lowest rate since 2010, CMS revealed. While this is good news, it still means Medicare lost $31.6 billion in avoidable billing errors in 2018, according to the Council for Medicare Integrity, a nonprofit advocacy organization focused on combating improper Medicare payments. Overall, the organization estimates Medicare lost more […]

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 […]

If we want to cut Medicare spending, let’s stop spending billions on improper payments

Paul Ryan recently shared that this year Congressional Republicans will focus on making significant 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. Interestingly, while on the campaign trail, President Trump passionately promised the American people that there would be no cuts to the Medicare, Medicaid or Social Security programs on his watch. So, is it at all possible for Congressional Republicans to […]

Medicare’s hospital audit regime

Medicare paid hospitals more than $180 billion in 2016, and the feds continue to conduct aggressive audits that claw back money based on inappropriate billing, Axios’ Bob Herman reports. The latest target: the University of Michigan Health System. HHS’ inspector general says UMHS has to forfeit $6.2 million after it found erroneous billing patterns with the system’s inpatient rehab claims, among other medical claims. UMHS disagreed with portions of the federal audit. Other hospital systems have been hit with even bigger clawbacks: […]

HHS OIG: University of Michigan Health System overbills Medicare by $6.2 million

The CMS overpaid the University of Michigan Health System $6.2 million and it should refund the federal government, according to HHS’ Office of Inspector General. The agency reviewed claims from 2014 and 2015 and found that the hospital did not fully comply with Medicare billing requirements for 73 claims that contained errors, resulting in overpayments. The health system did not have adequate controls to prevent the incorrect billing of Medicare claims, according to the OIG. The health system disagreed with some […]

Wasteful Medicare spending increases beneficiary out-of-pocket costs

Currently 56 million Americans rely on Medicare for healthcare coverage that provides financial protection during their senior years. Unfortunately, most are unaware that within the Medicare program there’s no ceiling on the amount of out-of-pocket costs a beneficiary could be expected to pay for covered services. According to a recent report from the Commonwealth Fund, more than a quarter of all Medicare beneficiaries — 15 million people — spend a staggering 20 percent or more of their income on premiums plus medical care. […]