CMS must im­prove on pay er­rors, GAO re­port rec­om­mends

Modern Healthcare - - Late News -

The CMS needs to do a bet­ter job of ad­dress­ing and promptly cor­rect­ing ser­vice-spe­cific er­rors that re­sult in im­proper pay­ments dis­cov­ered through its Re­cov­ery Au­dit Con­trac­tor pro­gram, the Gov­ern­ment Ac­count­abil­ity Of­fice rec­om­mended in a re­port. The RAC pro­gram al­lows third-party au­di­tors hired by the CMS to keep 9% to 12.5% of provider pay­ments they iden­tify as im­proper. The pro­gram was pi­lot-tested in sev­eral states from March 2005 to March 2008, re­coup­ing more than $992 mil­lion in over­pay­ments to providers. The CMS’ goal is to have a per­ma­nent pro­gram op­er­at­ing in all 50 states this year, with four con­trac­tors each hav­ing ju­ris­dic­tion for one-quar­ter of the coun­try. What was miss­ing from the demon­stra­tion project and in the plan­ning for the na­tional pro­gram was an ad­e­quate process for tak­ing cor­rec­tive action or suf­fi­ciently mon­i­tor­ing or con­trol­ling th­ese types of er­rors or “vul­ner­a­bil­i­ties,” the GAO stated. The watch­dog agency rec­om­mended that the CMS ap­point per­son­nel to eval­u­ate and swiftly ad­dress th­ese ser­vice-spe­cific er­rors. The CMS agreed with the GAO’s rec­om­men­da­tions.

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