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Tag : Medicare

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 […]

McKnights

Congress should require more Medicare claim auditing — before and after payment

At the beginning of the year, Congressional Republicans shared that they will focus on making broad 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. Unfortunately, the Medicare program has been facing solvency concerns stemming from increasing healthcare costs and beneficiary populations. Medicare trustees report that without changes to program spending, Medicare Part A will start paying out more […]

RACs Ask Azar To Let Them Review Additional Claims

The Council for Medicare Integrity, which represents Recovery Auditors, is asking HHS Secretary Alex Azar to let RACs audit more claims and to push Congress for a permanent RAC prepayment review program. The RACs say the audits “have absolutely no direct impact on the Medicare providers” but past provider complaints about audits led to program reforms. In a March 6 letter to Azar, the council asks his “support of the Medicare integrity programs put in place by Congress to prevent […]

Advocacy Group Urges HHS Secretary to Reduce Medicare Waste to Bolster the Budget

Washington, D.C. – Today, the Council for Medicare Integrity (CMI) sent a letter to Department of Health & Human Services (HHS) Secretary Alex Azar asking for expanded efforts to reduce improper billing within Medicare to decrease the need for planned program cuts. The letter praises the Secretary’s past successes with compliance efforts and his commitment to standards of excellence in government management while urging the application of those important ideals to bolster program integrity efforts that protect Medicare resources. “Today, […]

Loophole allows low volume Medicare providers exemption from auditing

In May 2016, the Centers for Medicare & Medicaid Services announced new additional documentation request (ADR) limitsfor Medicare Recovery Audit Contractors (RACs) 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. However, after three 45-day billing periods, CMS would then review provider billing accuracy rates and adjust each provider’s ADR limit higher or lower based on their […]

Low Volume Medicare Providers Get “Free Pass” From Auditing

Washington, D.C. – The Centers for Medicare & Medicaid Services (CMS) implemented new additional document request (ADR) limits last year that restrict Medicare recovery auditors to review no more than 0.5 percent of a provider’s total number of Medicare claims. The new ADR policy renders 99.5 percent of Medicare claims off limits from review for billing accuracy and has produced another side effect – low volume providers are now mathematically exempt from audits entirely. For example, any Medicare provider that […]

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 […]