Advocacy group intensifies push for prepayment audits as Medicare loses $36.1B


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 & Medicaid Services still lost $31.6 billion that year due to errors.

Council spokeswoman Kristin Walter said the need is greater than ever for Medicare to conduct auditing before payment is issued to try and pare down the error rate further.

“We urge CMS and Congress to boost Medicare oversight by authorizing a new level of resource protection — prepayment claim reviews – to catch and correct Medicare billing errors before claims are paid, and ensure that providers are reimbursed quickly and accurately the first time,” she said in the announcement.

CMS previously used such audits during the Medicare Prepayment Review Demonstration project in fiscal 2012, the council noted. Auditors then were authorized to review error prone Medicare claims for billing accuracy before payment, which resulted in the prevention of more than $192 million in erroneous reimbursement.

The council noted that these payment mistakes are separate from Medicare fraud and typically stem from coding errors, double billing, upcoding and insufficient documentation. All told, the trust fund has lost more than $230 billion to error over the past six years.

Read the article here.

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