Medicare: Claim Review Programs Could Be Improved with Additional Prepayment Reviews and Better Data

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By Kathleen M. King (au)
Year: 2016
Pages: 40
Binding Paperback
ISBN 978-1-4578-6431-5

Product Code: 1457864312

Description

The Centers for Medicare & Medicaid Services (CMS) uses several types of claim review contractors to help reduce improper payments and protect the integrity of the Medicare program. CMS pays its contractors differently -- the agency is required by law to pay Recovery Auditors (RAs) contingency fees from recovered overpayments, while other contractors are paid based on cost. Questions have been raised about the focus of RA reviews because of the incentives associated with the contingency fees. This report examines (1) differences between prepayment and postpayment reviews and the extent to which contractors use them; (2) the extent to which the claim review contractors focus their reviews on different types of claims; and (3) CMSäó»s cost per review and amount of improper payments identified by the claim review contractors per dollar paid by CMS. Tables. This is a print on demand reprt.

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