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GAO to CMS: Streamlining audits would reduce administrative burden

August 22, 2013

The Centers for Medicare & Medicaid Services should make post-payment review more efficient for health care providers by improving consistency across the four Medicare private contractors, the Government Accountability Office said in a report today. CMS should examine contractor post-payment review requirements to determine those that could be made more consistent; communicate its findings and time frame for taking action; and reduce differences where possible without impeding efforts to reduce improper payments, GAO said. “Having inefficient processes that complicate compliance can reduce effectiveness of claims reviews, and is inconsistent with executive-agency guidelines to streamline service delivery and with having a strong internal control environment,” the report states. Recovery Audit Contractors – which are paid contingency fees on the amount of claims recouped – conducted almost five times as many reviews as all other Medicare auditors combined in fiscal year 2012, GAO found. The AHA-backed Medicare Audit Improvement Act of 2013 (S. 1012/H.R. 1250), introduced in response to hospital concerns, would correct persistent operational problems by the RACs, establish manageable limits on record requests, correct CMS policies that provide hospitals with less than full payment for necessary care, and require transparent reporting of RAC audits and appeals. For more information, see the recent AHA Action Alert for members.