Tag : Prepayment Reviews

Congress needs to give CMS the authority to conduct prepayment reviews

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule (CMS-4182-F) that updates the Medicare Advantage (MA) and Medicare prescription drug benefit program (Part D). This will provide incentives to encourage fraud reduction activities defined as the prevention, identification and recovery of fraud. CMS notes that reducing fraud can improve patient safety, deter the use of medically unnecessary services and can lead to higher levels of health-care quality. We agree. We also support CMS’ assertion that fraud reduction activities are particularly […]

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 […]