Af­ter op­po­si­tion, CMS stalls two anti-fraud projects

Modern Healthcare - - LATE NEWS -

The CMS de­layed two anti-fraud demon­stra­tion projects that drew heavy provider op­po­si­tion af­ter they were an­nounced in Novem­ber, ac­cord­ing to a no­tice on the agency’s web­site. One pi­lot would re­quire prior au­tho­riza­tion for scoot­ers and power wheel­chairs pre­scribed for Medi­care ben­e­fi­cia­ries liv­ing in any of the seven states with the high­est con­cen­tra­tion of fraud or billing er­rors: Cal­i­for­nia, Illi­nois, Michi­gan, New York, North Carolina, Florida and Texas. The preau­tho­riza­tion process was de­vised to en­sure that med­i­cal con­di­tions war­rant the med­i­cal equip­ment, ac­cord­ing to the CMS. An­other de­layed project would al­low re­cov­ery au­dit con­trac­tors to re­view claims be­fore they are paid, fo­cus­ing on the types of claims his­tor­i­cally as­so­ci­ated with high rates of im­proper pay­ments in seven states (Florida, Cal­i­for­nia, Michi­gan, Texas, New York, Louisiana and Illi­nois) and claims with high vol­umes for short in­pa­tient hos­pi­tal stays in four states (Penn­syl­va­nia, Ohio, North Carolina and Mis­souri). CMS of­fi­cials said the RAC ex­pan­sion would lower Medi­care’s er­ror rate by pre­vent­ing im­proper pay­ments, rather than the tra­di­tional “pay and chase” meth­ods of look­ing for im­proper pay­ments af­ter they oc­cur. The agency plans to pro­vide at least 30 days’ no­tice be­fore the de­layed demon­stra­tion projects be­gin. A third demon­stra­tion pro­gram an­nounced at the same time was slated to be­gin, as planned, on Jan. 1. It will al­low hos­pi­tals to re-bill for 90% of the

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