Long-Term Care

LTC providers bear burden of poor oversight of Medicare auditors

MDS 3.0 Insider, August 14, 2014

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Long-term care and other providers could be facing unfair burdens due to ineffective government oversight of Medicare auditors, according to a new report from the Government Accountability Office.

The Centers for Medicare & Medicaid Services does keep a database to track Recovery Audit Contractor activity and prevent them from reviewing the same claim multiple times, the investigation determined. However, the three other types of auditors do not consistently enter information into this database. RACs explicitly are not allowed to review claims that have been evaluated by other contractors, but CMS has not “developed complete guidance” about whether non-RAC auditors can undertake duplicative reviews.
 
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