CMS set to be­gin de­layed anti-fraud pro­grams June 1

Modern Healthcare - - LATE NEWS -

Two CMS anti-fraud pro­grams, whose Jan. 1 launch was scrubbed be­cause of provider con­cerns, will start June 1 in­stead, ac­cord­ing to the agency. One will 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 (Cal­i­for­nia, Florida, Illi­nois, Louisiana, Michi­gan, New York and Texas) and claims with high vol­umes for short in­pa­tient hospi­tal stays in four states (Mis­souri, North Carolina, Ohio and Penn­syl­va­nia). A pi­lot pro­gram that will re­quire prior au­tho­riza­tion for scoot­ers and power wheel­chairs pre­scribed for Medi­care ben­e­fi­cia­ries, how­ever, was “sig­nif­i­cantly” redesigned and will launch in Cal­i­for­nia, Florida, Illi­nois, Michi­gan, New York, North Carolina and Texas. That pi­lot will no longer re­quire prior au­tho­riza­tion for 100% of the claims for the equip­ment.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.