CMS announces major efforts to help reduce Medicare, Medicaid improper payments
Medicare Update for CAHs, November 30, 2011
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.
Related Products
-
Core Skills for Hospital Case Managers:
A guide to fundamental case management responsibilities, Core Skills for Hospital Case Managers serves as a training...
-
Combat RAC Denials: Strategies for Successful Appeals
During this 90-minute audio conference, our speakers provide step-by-step procedures, timelines, tools, and best practices...
-
The 2013 Medicare Compliance Forum: Las Vegas, NV
-
Level of Care Determinations for 2014: Las Vegas, NV
Attend the half-day seminar, Outpatient, Observation or Inpatient? Continuing to Walk the Tightrope of Regulatory Guidance...
-
OPPS and IPPS Reimbursement Fundamentals: Las Vegas, NV
Attend OPPS and IPPS Reimbursement Fundamentals, a half-day seminar on October 2nd in Las Vegas. Learn how CMS’ substantial...
Most Popular
- Articles
-
- Note similarities and differences between HCPCS, CPT® codes
- Know the medical gas cylinder storage requirements
- Steps for maintaining patient privacy
- Don't forget the three checks in medication administration
- Poor documentation: The consequences
- The consequences of an incomplete medical record
- Practice the six rights of medication administration
- Complications from immobility by body system
- OB services: Coding inside and outside of the package
- ICD-10-CM coma, stroke codes require more specific documentation
- E-mailed
-
- Q&A: Coding drug administration for observation patients
- Update: E/M pay cut tied to modifier 25 affects only certain payer plans
- Q/A: Coding 'in and out' bladder catherizations
- Performing a SWOT analysis
- MDS 101: How to train the MDS newbie
- Five ways to safeguard your patients' valuables
- Don't bill 59025, 76818 separately without separate physician orders
- Coding, billing, and documentation tips for teaching physicians, interns, residents, and students
- Coding Clinic for CDI:Reassessing debridement documentation
- Searched