Congress questions Medicare audit coordination

A bipartisan group of senators and representatives Tuesday asked the Government Accountability Office (GAO) to analyze how the Centers for Medicare & Medicaid Services coordinates Medicare audits to avoid duplicative efforts and inconsistent standards, reported the Washington Examiner.

Congress wants GAO to study efficiency within the Medicare program and coordination among its various contractors, which include Medicare Administrative Contractors, Medicare Recovery Auditors, Zone Program Integrity Contractors, Program Safeguard Contractors and Comprehensive Error Rate Testing Review Contractors.

"Healthcare providers are responsible for interacting with, and responding to, each of these contractors," they wrote in the letter. "In order for this contractor oversight to at once be effective at detecting improper payments and not unnecessarily burdensome to providers, it must be undertaken subject to a coherent strategic plan, consistent standards and active coordination," they said.

The GAO has been critical of Medicare oversight of late, saying CMS is leaving billions of dollars on the table by not acting on its recommendations. For instance, even though in 2007 GAO advised CMS require contractors to develop automated prepayment controls to identify improper claims, CMS has yet to implement them, according to a May report.

In February, OIG also called on CMS to use a reliable methodology for adjusting the national Medicare fee-for-service error rate. If CMS overturned Comprehensive Error Rate Testing denials in its error rate calculations, OIG said the estimated value of reported errors in 2009 and 2010 would have dropped by about $2 billion each year.

To learn more:
- read the letter (.pdf)
- here's the Washington Examiner article

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