CMS announces major efforts to help reduce Medicare, Medicaid improper payments
Medicare Update for CAHs, November 30, 2011
Want to receive articles like this one in your inbox? Subscribe to Medicare Update for CAHs!
As part of the ongoing effort to reduce improper payments in Medicare and Medicaid, CMS announced on November 15 that it will launch a number of demonstration programs beginning in January 2012 that will target some of the most common factors that lead to erroneous payments. The top two issues that have the most dramatic impact on providers are the launch of a recovery audit prepayment review program and a Part B rebilling initiative.
In the prepayment review demonstration program, recovery auditors (formerly known as RACs), will be allowed to review claims before they are paid to ensure that the provider complied with all Medicare payment rules, according to the CMS release. The recovery auditors will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. The reviews will take place in seven states with high populations of fraud- and error-prone providers: Florida, California, Michigan, Texas, New York, Louisiana and Illinois. The demonstration will also focus on four states with high claims volumes of short inpatient stays: Pennsylvania, Ohio, North Carolina and Missouri. This 11-state demonstration project aims to help lower the error rate by preventing improper payments rather than the traditional “pay and chase” methods of looking for erroneous payments are they’ve been made, according to CMS.
For some, the initial reaction to the announcement of prepayment review may be unfavorable, but it should actually be a positive development for providers, says Kimberly Hoy, JD, CPC, director of Medicare and compliance for HCPro, Inc.
Continue reading on HCPro’s Revenue Cycle Institute.
Want to receive articles like this one in your inbox? Subscribe to Medicare Update for CAHs!
Related Products
-
2010 RAC Track: Medicare Compliance Forum Audio Recording
On-demand audio recordings of the RAC track of HCPro Revenue Cycle Institute's popular Medicare Compliance Forum, held May...
-
Medicare Compliance Forum: Orlando, FL
Attend the 2012 Medicare Compliance Forum to reduce your organization’s risk and exposure from government auditors...
-
Outpatient, Observation, or Inpatient?
Attend the half-day seminar, Outpatient, Observation or Inpatient? Walking the Tightrope of Regulatory Guidance, September...
-
OPPS and IPPS Reimbursement Fundamentals
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on September 30 in Orlando. You'll learn to understand...
-
2010 Observation Services Track:
On-demand audio recordings of the Observation Services track of HCPro Revenue Cycle Institute's popular Medicare Compliance...
Most Popular
- Articles
-
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Topic: CMS, OESS post new security compliance review information, checklist
- HIPAA Q&A: Answering service messages
- Q/A: Volume requirement for reporting hydration services
- News and briefs: Oklahoma Osteopathic Association against residency bill change
- What does case-mix index mean to you?
- QA:Coding multiple initial infusions
- OB services: Coding inside and outside of the package
- Are your workforce members texting PHI?
- CMS issues IPPS proposed rule for FY 2013
- E-mailed
-
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- Are your workforce members texting PHI?
- Don't let these sentinel events trigger falsely
- Arkansas woman convicted for HIPAA violation
- Reasons for inadequate fluid intake in the elderly
- Q&A tackles coding questions about injections and infusions
- Joint Commission Center announces handoff communication solutions
- Inside best practice: Reduce patient falls with a stoplight
- Identify modifiable risk factors to prevent patient falls
- Hospitalist-surgeon comanagement has no effect on outcomes
- Searched