Advocacy group intensifies push for prepayment audits as Medicare loses $36.1B The Council for Medicare Integrity is upping its push for the use of prepayment audits in the Medicare program, noting that tens of billions have been lost due to errors. In an announcement last week, the advocacy group noted that the federal government has been able to drop the error rate in Medicare fee-for-service billing from 9.5% down to 8.1% during the 2018 fiscal year. Yet the Centers for Medicare & […]
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 […]
Error Rate Drops, but Medicare Still Lost $31.6 Billion to Preventable Billing Errors in FY2018 Prepayment claim reviews could stem this loss and add billions back into the federal budget Washington, D.C. (November 20, 2018) – The Centers for Medicare and Medicaid Services (CMS) has released the latest data pertaining to the Medicare Fee-for-Service (FFS) billing error rate. The agency reports that during the 2018 fiscal year, although the error rate dropped from 9.5% to 8.1%, this still resulted in […]
Auditors Recouped $214M in Medicare Improper Payments in 2016 Medicare Recovery Audit Contractors (RACs) corrected 7.5 percent more claims in 2016, resulting in greater recoupment of Medicare improper payments. September 28, 2018 – Recovery Audit Contractors (RACs) returned significantly more Medicare improper payments to the program’s trust fund during the 2016 fiscal year (FY), a recent CMS report to Congress shows. In FY 2016, the Medicare auditors returned a net of $214.09 million to the Medicare Trust Fund after accounting for administrative and operating […]
Report to Congress finds $474M in improper payments from fee-for-service Medicare A tweak to the federal government’s methods of auditing healthcare payment programs has scaled back the number of discovered improper payments. That’s according to the latest report to Congress on 2016 work done by Recovery Audit Contractors in fee-for-service Medicare. The RAC program was put in place to review provider payments, after they’ve been issued, to root out improper payments. The report noted that in fiscal 2016, RACs found improper payments […]
Medicare auditors saved program $214M in FY 2016 and 7 other things to know The Medicare Recovery Audit Contractor program corrected $404.46 million in overpayments and $69.46 million in underpayments in fiscal year 2016, according to CMS’ report to Congress. Eight things to know about the 2016 results: 1. In 2016, recovery audit contractors corrected $473.92 million in improper payments, including overpayments collected and underpayments repaid to healthcare providers. That’s up 7.5 percent from $440.69 million the year prior. 2. Sixty-three percent […]
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 […]
MEDICARE TO ELIMINATE APPEALS BACKLOG WITHIN 4 YEARS, HHS TELLS JUDGE For years the Health and Human Services Office of Medicare Hearings and Appeals (OMHA) has been unable to keep up with the number of cases it receives, leading to a mountainous backlog of pending appeals. That backlog shrank, however, by more than 30% in the past year, dropping from more than 650,000 pending appeals last year to less than 445,000 late last month, according to documents HHS filed Friday in […]
Private sector best practices can improve Medicare solvency Last week, the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma delivered a speech at the Commonwealth Club sharing that the agency has a long way to go to prevent Medicare waste, fraud and abuse. She went on to say that the agency must learn from the private sector how to be more fiscally efficient. Administrator Verma cited that the Medicare program only reviews three tenths of one percent of all claims […]
Verma: CMS Has A Long Way To Go To Improve Medicare Program Integrity CMS Administrator Seema Verma said the agency has a long way to go to prevent Medicare waste, fraud and abuse, and pointed to the small percentage of claims that Medicare reviews, though Center for Program Integrity Director Alec Alexander recently touted Medicare’s falling improper pay rate before a House Ways & Means panel. Some providers and one beneficiary advocate raised concerns that Verma’s remarks could indicate a […]