Fewer physicians could face audits under CMS program

CMS will move toward more targeted Medicare audits.

The government is taking another step to reduce the regulatory burden on physicians—this time with fewer, more targeted Medicare audits.

Fewer physicians will undergo audits under a new Medicare claims review process, according to a Centers for Medicare & Medicaid Services announcement.

CMS will roll out a new approach to claims review nationwide that targets fewer providers and requires the review of fewer claims. The new policy, to take effect later this year, makes it less likely doctors who have sound billing practices will face a Medicare audit.


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It’s the latest in a series of actions to reduce the regulatory burden on doctors, which both Health and Human Services Secretary Tom Price and CMS' head, Seema Verma, have said is a priority for the Trump administration.

For example, CMS issued a proposed rule in June that updates the Medicare physician payment system implemented under MACRA with changes that would make it easier for small independent and rural practices to participate. The comment period on that proposed rule closes today.

RELATED: CMS releases updated proposed rule for MACRA, eases burden on small and rural practices

In the latest change revealed in an update on the CMS website, the agency said it is revising its medical review process to target only specific providers or suppliers who have billed Medicare for particular services, rather than all of them. Under the so-called Targeted Probe and Educate program, Medicare Administrative Contractors will focus “only on providers/suppliers who have the highest claim error rates or billing practices that vary significantly out from their peers,” CMS said.

That's good news providers who do not have a high claim error rate or unusual billing practices.

As part of the Trump administration’s commitment to reduce government regulations, CMS last week rescinded two new bundled payment programs that were scheduled to start Jan. 1, 2018.

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