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Tag : RAC

MEDICARE TO ELIMINATE APPEALS BACKLOG WITHIN 4 YEARS, HHS TELLS JUDGE

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 […]

Verma: CMS Has A Long Way To Go To Improve Medicare Program Integrity

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 […]

AHA Medicare appeals reform recommendations miss the mark

AHA Medicare appeals reform recommendations miss the mark Last week, the American Hospital Association (AHA) filed a brief with the federal court in response to U.S. District Judge James Boasberg’s request for ideas to address the current Medicare appeals backlog. Instead of making substantive administrative recommendations to improve the Medicare appeals process, the AHA makes suggestions that are not only redundant based on existing Centers for Medicare and Medicaid Services (CMS) rules. It also clearly demonstrate that the AHA is more interested […]

Amid dire economic reports, wasteful Medicare spending must stop

Amid dire economic reports, wasteful Medicare spending must stop According to the latest economic outlook report from the Congressional Budget Office, the 2018 federal deficit will total $804 billion – $139 billion more than the $665 billion shortfall recorded in 2017 – and is expected to grow substantially over the next several years. What’s causing such rapid increases to the deficit? Mandatory federal spending continues to rise predominantly due to growth in Social Security and Medicare outlays. These increases are driven by the combination of […]

Congress needs to do something about improper Medicare billing practices

Congress needs to do something about improper Medicare billing practices The Medicare Trustees have released a new report predicting that  the inpatient Trust Fund will soon begin paying out more in benefits than it collects in payroll taxes from American paychecks. Medicare Part A will only be able to manage this financial gap until 2026, after that, the program will have no choice but to scale back inpatient hospital coverage — adding more out-of-pocket burden on seniors. The trustees report calls on Congress […]

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 […]

District Court Again Asks Hospitals To Propose Solution To Appeals Backlog

The D.C. District Court told hospitals to come up with proposals by June 22 to clear out the backlog of Medicare appeals and to explain why current procedures are insufficient, and the government will have until July 6 to respond to those proposals, according to a recent court order. The American Hospital Association sued HHS over the appeals backlog because decisions at the Administrative Law Judge level were not turned around within 90 days as required by law. After gathering […]

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 […]