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House Energy & Commerce Oversight and Investigations Subcommittee Discuss the Medicare and Medicaid Program Integrity

Posted on Monday, June 6, 2016 12:55 PM

A hearing was held by the U.S. House of Representatives Energy & Commerce Oversight and Investigations Subcommittee on May 24, 2016, titled, “Medicare and Medicaid Program Integrity: Combatting Improper Payments and Ineligible Providers.”

Subcommittee Chairman Tim Murphy (R-PA) outlined the 2015 estimates that were released by HHS, including the following estimate measures:
• $89 million dollars in improper payments through Medicare and Medicaid fee-for-service
• 9.8 percent in Medicaid fee-for-service
• 12.1 percent in Medicare fee-for-service.

Dr. Shantanu Agrawal, Deputy Administrator and Director of the Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS), discussed the rate of improper payments and the steps CMS should take in reducing the rates. Dr. Agrawal said, “Seventy percent of the rate is provider-driven documentation issues. That is, for example in the home health space, lack of coordination between the ordering physician and the home health agency.”

In order to address these problems with improper payments, Dr. Agrawal said the following steps need to be taken into consideration:
• Clarifying requirements to improve compliance
• Implementing education programs for all home health agencies

Due to new documentation requirements, most of the documentation problems are associated with the home health face-to-face requirements. NAHC believes that CMS must remove the current documentation requirements, where the home health agencies are being held accountable for a physician’s documentation. NAHC remains persistent in finding a legislative remedy to face-to-face documentation with bipartisan, bicameral support.

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