CMS Proposes Settlement Option to Resolve Patient Status Claim Denials Pending in the Medicare Appeals Process

On August 29, 2014, CMS announced it will offer “an administrative agreement to any hospital willing to withdraw their pending appeals in exchange for timely partial payment (68% of the net allowable amount)”, in an effort to quickly reduce the volume of inpatient claim denials pending in the Medicare appeals process. Currently, Acute Care Hospitals (including those paid via Prospective Payment System (PPS), Periodic Interim Payments (PIP), and Maryland waiver; as well as Critical Access Hospitals are eligible to submit… Read More >

Senate Report Finds Medicare Audit Programs Have Failed to Reduce Improper Payment Rate

The Senate Special Committee on Aging recently issued a report addressing the current Medicare audit programs, the impact of these programs on reducing improper payment rates and the burden providers face when undergoing a Medicare audit. The report outlines inefficiencies related to the lack of coordination among the audit contractors and the failure to effectively target problem providers or problem areas. The report notes that in fiscal year (FY) 2013, CMS reported an estimated $50 billion in Medicare fee-for-service improper… Read More >

Legislators Voice Concerns Over Troubled Medicare Appeals Process

Legislators voiced concerns over aggressive Medicare audit contractors and the current Medicare appeals process in a congressional hearing on May 20, 2014. As reported by Modern Healthcare, legislators from both sides of the aisle voiced concerns regarding federal investigations into potential Medicare fraud having the collateral effect of unfairly punishing providers who have done nothing wrong. While there is a strong desire to stop Medicare fraud, there is also serious concern that the current Medicare appeals process used by providers… Read More >

House Lawmakers Call for Immediate Reform to the Recovery Audit Contractor (RAC) Process

A bipartisan group of House members called for immediate reforms to the Medicare RAC program in a February 10, 2014 letter to HHS Secretary Kathleen Sebelius.  The letter cites the structure of the RAC audit and payment system as the key problem:  RACs are permitted to audit medical records and claims three years after the services have been provided and are paid a commission on the dollar amount of the claims they deny.  The payment structure incentivizes RACs to deny claims… Read More >