The federal government is losing $48 billion a year in improper payments partly due to CMS' failure to adopt more money-saving tactics, according to a report by the Government Accountability Office.
The GAO's report, "MEDICARE: Program Remains at High Risk Because of Continuing Management Challenges," lists a variety of shortcomings in the program:
Payment reform. While CMS has altered some physician reimbursements to recognize efficiencies gained when services are furnished together, it has not targeted services with the greatest potential for savings, such as imaging and oxygen services.
Program management. CMS has not fully addressed previous GAO recommendations to revamp oversight of Medicare contractors, address a backlog of contacts and investigate more than $70 million in payments.
Payment vulnerabilities. CMS has not set up a complete process to follow up on payment vulnerabilities identified by recovery audit contractors, and it has not started conducting post-payment reviews of claims submitted by home health agencies with high rates of improper billing, as GAO recommended.
Nursing home quality. Though CMS oversight of nursing home quality has improved, its survey methodology and guidance for surveillance are still weak.
GAO said CMS should refine payment methods in the following ways:
• Implement an effective physician-profiling system
• Improve managing payments for imaging and other services
• Revamp payments to reflect efficiencies providers realize when two or more services are commonly provided together
• Refine geographic adjustments of physician payments by applying uniform physician payment localities
Read the GAO report "MEDICARE: Program Remains at High Risk Because of Continuing Management Challenges. (pdf)"
Read more coverage of CMS oversight of Medicare:
- Federal Report Urges CMS to Address Overpayment Issues Identified by RACs
- Incoming House Oversight Chair Targets Orthopedic, Other Medical Devices
- GOP Lawmakers Prepare to Grill CMS Administrator Don Berwick
The GAO's report, "MEDICARE: Program Remains at High Risk Because of Continuing Management Challenges," lists a variety of shortcomings in the program:
Payment reform. While CMS has altered some physician reimbursements to recognize efficiencies gained when services are furnished together, it has not targeted services with the greatest potential for savings, such as imaging and oxygen services.
Program management. CMS has not fully addressed previous GAO recommendations to revamp oversight of Medicare contractors, address a backlog of contacts and investigate more than $70 million in payments.
Payment vulnerabilities. CMS has not set up a complete process to follow up on payment vulnerabilities identified by recovery audit contractors, and it has not started conducting post-payment reviews of claims submitted by home health agencies with high rates of improper billing, as GAO recommended.
Nursing home quality. Though CMS oversight of nursing home quality has improved, its survey methodology and guidance for surveillance are still weak.
GAO said CMS should refine payment methods in the following ways:
• Implement an effective physician-profiling system
• Improve managing payments for imaging and other services
• Revamp payments to reflect efficiencies providers realize when two or more services are commonly provided together
• Refine geographic adjustments of physician payments by applying uniform physician payment localities
Read the GAO report "MEDICARE: Program Remains at High Risk Because of Continuing Management Challenges. (pdf)"
Read more coverage of CMS oversight of Medicare:
- Federal Report Urges CMS to Address Overpayment Issues Identified by RACs
- Incoming House Oversight Chair Targets Orthopedic, Other Medical Devices
- GOP Lawmakers Prepare to Grill CMS Administrator Don Berwick