GAO to CMS: Streamlining audits would reduce administrative burden   08/22/2013
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.
Back-up paper forms available to submit IPF quality measures   08/22/2013
Inpatient psychiatric facilities having difficulty submitting quality data using the Centers for Medicare & Medicaid Services’ online application may submit data using back-up paper forms, CMS announced today. IPFs that need the forms may obtain them from CMS support contractor Telligen by emailing or calling (888) 961-6425. Telligen also plans to post the forms to QualityNet as soon as possible. IPFs and distinct-part psychiatric units in acute care hospitals are eligible to participate in the IPF quality reporting program. Participating facilities must submit the Notice of Participation and required measures by tomorrow, Aug. 23, to receive a full payment update in Fiscal Year 2014.
Hospitals can preview HAC data beginning Monday   08/22/2013
Beginning Monday, hospitals can confidentially preview hospital-level results for eight hospital-acquired condition measures that will be posted at in late September, the Centers for Medicare & Medicaid Services announced today. The hospital-specific reports, which will be available at are based on CMS fee-for-service claims from July 1, 2010 through June 30, 2012. Hospitals without qualifying data during the period, or that were not open as of May 10, 2013, may access “mock” hospital-specific reports at QualityNet. For help accessing hospital-specific reports, contact the QualityNet help desk at These measures are not those that CMS recently adopted for the HAC payment penalty program. Additionally, because the measures are not part of the inpatient quality reporting program, they will not be posted on the Hospital Compare website. However, hospitals are encouraged to review their results since the HAC measure data may be used in publicly available report cards assessing hospital performance, such as the Leapfrog Hospital Safety Score.
Reminder: Deadline for submitting LTCH, IRF quality data tomorrow   08/22/2013
The deadline for long-term care hospitals and inpatient rehabilitation facilities submitting first-quarter data for the LTCH and IRF quality reporting programs is tomorrow at 11:59 p.m. Pacific Time. The original Aug. 15 deadline was extended to Aug. 23 due to data submission challenges with the Centers for Medicare & Medicaid Services and National Healthcare Safety Network systems. Under the Patient Protection and Affordable Care Act, LTCHs and IRFs must submit certain quality data to avoid a 2 percentage point reduction in their annual payment update beginning Oct. 1.