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GAO Report Focuses on Medicare Administrative Contractors

Posted on Thursday, April 20, 2017 2:23 PM

A report was released by the Government Accountability Office (GAO) on "Medicare Provider Education: Oversight of Efforts to Reduce Improper Billing Needs Improvement." The report takes a close look at the Medicare Administrative Contractors (MACs).

The GAO found the following:
• MACs haven’t focused their efforts on areas, such as improper payments
• MACs are not required to educate referring providers (physicians)
• The Centers for Medicare and Medicaid Services (CMS) cannot determine the effectiveness of the "probe and educate" program because it lacks evaluation metrics

The GAO recommends the following for CMS:
• Require sufficient detail in MAC reporting to allow CMS to determine the extent to which MACs' provider education department on vulnerable areas
• Require that A/B, DME, and HH+H MACs work together to educate referring providers on documentation requirements for DME and home health services
• CMS should establish performance metrics for future “probe and educate” reviews
The Department of Health and Human Services agreed with the recommendations that were released by GAOs. Included in the report are their written comments.

The GAO report confirms VNAA's claim that high rates of improper payment do not fully represent fraud and program abuse.

For the full article, please see the April 18, 2017 VNAA Member Update.

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