CMS’ con­trac­tors may du­pli­cate au­dits: GAO

Modern Healthcare - - NEWS - By Bob Her­man

The CMS’ au­dit con­trac­tors may over­lap du­ties and ham­mer hos­pi­tals with mul­ti­ple re­views of the same pay­ment claims, ac­cord­ing to a Govern­ment Ac­count­abil­ity Of­fice re­port that cor­rob­o­rates provider con­cerns.

Although the CMS re­port­edly has sys­tems in place to pre­vent con­trac­tors from con­duct­ing du­plica­tive au­dits, the GAO said the CMS’ over­sight mea­sures are not suf­fi­cient or re­li­able.

The GAO looked at re­cov­ery au­dit con­trac­tors, Medi­care ad­min­is­tra­tive con­trac­tors, zone pro­gram in­tegrity con­trac­tors and com­pre­hen­sive er­ror rate test­ing con­trac­tors.

The GAO con­cluded that post-pay­ment Medi­care re­views are es­sen­tial to re­duce waste in the pro­gram, but that the CMS should take steps to “im­prove the ef­fi­ciency and ef­fec­tive­ness of its con­trac­tors’ ef­forts.”

Namely, the agency should mon­i­tor its re­cov­ery au­dit data­base to en­sure all con­trac­tors are sub­mit­ting ac­cu­rate, com­plete data, and it should rou­tinely as­sess the au­di­tors so they are not over­lap­ping du­ties or over­bur­den­ing providers.

The CMS said it agreed with the rec- om­men­da­tions and it would ad­dress them. The Amer­i­can Hos­pi­tal As­so­ci­a­tion said it sup­ported the GAO’s con­clu­sions. The Amer­i­can Coali­tion for Health­care Claims In­tegrity, a group rep­re­sent­ing the con­trac­tors, said the over­sight pro­grams should be re­fined based on provider and au­di­tor feed­back.

Ear­lier this month, the CMS al­lowed the re­cov­ery au­dit con­trac­tors to restart some re­views of hos­pi­tal claims. The pro­gram had been on hia­tus since June 1, when the com­pa­nies’ au­dit con­tracts ex­pired.

CMS’ over­sight mea­sures are not suf­fi­cient or re­li­able.

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