Senators blast CMS for record payment errors

A Senate committee blasted the Centers for Medicare and Medicaid Services (CMS) Wednesday for failing to prevent record-high improper payments and for putting undue burden on falsely accused providers.

“The bottom line is, despite doing more audits than ever before, Medicare just isn't getting the job done when it comes to preventing payment errors,” said Sen. Bill Nelson (D-Fla.), chairman of the Senate Special Committee on Aging. “Medicare must change the way it pays its providers so that the cheats are getting caught and the honest providers are getting paid.”

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The committee released a bipartisan report Wednesday that says improper Medicare payments are at a record high and that the CMS hasn't done enough to fix the problem.

The report notes improper Medicare payments have climbed from 8.5 percent in 2012 to 10.1 percent in 2013, despite the fact the CMS has hired more recovery audit contractors (RACs) to track providers who may be overbilling for Medicare services.

"The increase in audits has not translated into a reduction in improper payments,” noted Sen. Susan Collins (R-Maine), ranking member on the committee. “In fact Medicare is currently experiencing its highest improper payment rate in five years."

The committee recommends the CMS's audits focus on providers who have made improper claims in the past, compensate auditors based on their ability to prevent improper payments, and improve its ability to track claims that have already been audited so there isn't any duplication.

Nelson and Collins said the RACs were putting undue burden on many providers who are eventually found to be innocent of fraud through the ringer and hurting their business.

“The incentive is out of whack,” said Nelson. “If the goal is you want to reduce the overall amount of improper payments that's what also ought to be what we're going after and compensate the contractors based on that instead of on the number of improper payments that they identify.”

Recently House lawmakers echoed Wednesday's Senate committee criticism. During a House subcommittee panel hearing lawmakers said RACs are more geared toward trying to get paid for every minor mistake rather than trying to prevent improper payments to Medicare.


Read more: http://thehill.com/policy/healthcare/211752-senators-blast-cms-for-record-medicare-fraud#ixzz3711kkEAj

ICD-10 Medical Code Tests Yield Successful Results for CMS

The Centers for Medicare and Medicaid Services’ claims acceptance rates approached the average for normal claims, and participants were able to test the impact of errors in claim reports during the process.

The Centers for Medicare and Medicaid Services’ initial testing of updated medical diagnosis codes that will be required at health care payers and providers next year proved to be successful, according to Niall Brennan, the acting director of CMS Offices of Enterprise Management.

The updated codes, ICD-10, replace ICD-9 to bring the U.S. up to speed with other industrialized countries and allow for more specific patient diagnoses.

After several delays, the implementation of ICD-10 will be required by Oct. 1, 2015.

All entities covered by the Health Insurance Portability and Accountability Act must implement the new codes to create consistency between the health care system in the United States and other industrialized countries.

Brennan, in a CMS blog post, said testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-for-service (FFS) claims systems and received electronic acknowledgments confirming their claims were accepted.

There were approximately 2,600 participating providers, suppliers, billing companies and clearinghouses during the week of testing, according to Brennan.

The largest testing group was from clearinghouses, which submit claims on behalf of health care providers, Brennan said. They submitted 50 percent of all the test claims.

In the U.S., CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent, according to Brennan. Medicare FFS claims system did not present any issues during the testing process. Normal claims acceptance rates average between 95 and 98 percent.

“This testing week allowed an opportunity for testers and CMS alike to learn valuable lessons about ICD-10 claims processing,” Brennan said. “In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing.”

In the near future, the Department of Health and Human Services expects to release an interim final rule that will include a new compliance date requiring the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9- through Sept. 30, 2015.

CMS will be releasing details about plans to conduct end-to-end testing in 2015, according to Brennan.

http://www.acainternational.org/healthcaremarket-icd-10-medical-code-tests-yield-successful-results-for-cms-32186.aspx