CMS ex­pects $370 mil­lion in im­proper pay­ment re­cov­ery

Modern Healthcare - - LATE NEWS -

The CMS said a new ef­fort to re­duce im­proper pay­ments in Medi­care Ad­van­tage plans will re­cover about $370 mil­lion in over­pay­ments in the first year. The CMS cal­cu­lates that the rate of im­proper pay­ments by Medi­care Ad­van­tage or­ga­ni­za­tions was about 11% in fis­cal 2011, or $12.4 bil­lion of the to­tal $112.2 bil­lion in the pro­gram. The CMS will iden­tify 30 plans each year that an­a­lysts will ex­am­ine in or­der to cal­cu­late a plan-spe­cific er­ror rate and over­pay­ment. Jonathan Blum, the CMS’ deputy ad­min­is­tra­tor and di­rec­tor for the Cen­ter for Medi­care at the CMS, said the au­dits aim to ul­ti­mately “change the be­hav­ior of Medi­care Ad­van­tage plans so they (the plans) en­sure that the di­ag­noses codes they sub­mit to the CMS are ac­cu­rate,” which will drive down the over­all er­ror rate. The CMS will choose a new sam­ple of 30 plans each year. “We will over­sam­ple those cod­ing the most ag­gres­sively,” Blum said. “We’re go­ing to tar­get those.” Mean­while, HHS’ in­spec­tor gen­eral’s of­fice is­sued a re­port find­ing that Ad­van­tage plans lack a “com­mon un­der­stand­ing” about fed­eral anti-fraud re­quire­ments. “Dif­fer­ences in the way or­ga­ni­za­tions de­fined and de­tected po­ten­tial fraud and abuse may ac­count for some of the vari­abil­ity in the num­ber of in­ci­dents they iden­ti­fied,” ac­cord­ing to the re­port. Three Demo­cratic mem­bers of the House En­ergy and Com­merce Com­mit­tee re­quested a hear­ing on the find­ings.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.