Centers for Medicare & Medicaid Services's Use of Medicaid Services' Use of Medicare Fee-for-Service Error Rate Date to Identify and Focus on Error-Prone Providers.
(10/04/2013)
The U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services (CMS), administers the Medicare program. CMS contracts with payment contractors to process and pay claims submitted by health care providers on behalf of Medicare beneficiaries. CMS also contracts with quality improvement organizations, recovery audit contractors (RAC), and program safeguard contractors (PSC) to, among other things, safeguard the Medicare program from improper payments. In fiscal year (FY) 2008, Medicare benefit payments totaled about $445 billion, including $310 billion in fee-for-service (FFS) payments. Medicare payments are projected to more than double to $914 billion by 2018. The Office...
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Centers for Medicare & Medicaid Services's Use of Medicaid Services' Use of Medicare Fee-for-Service Error Rate Date to Identify and Focus on Error-Prone Providers. | Số trang: 20
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The U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services (CMS), administers the Medicare program. CMS contracts with payment contractors to process and pay claims submitted by health care providers on behalf of Medicare beneficiaries. CMS also contracts with quality improvement organizations, recovery audit contractors (RAC), and program safeguard contractors (PSC) to, among other things, safeguard the Medicare program from improper payments. In fiscal year (FY) 2008, Medicare benefit payments totaled about $445 billion, including $310 billion in fee-for-service (FFS) payments. Medicare payments are projected to more than double to $914 billion by 2018. The Office of Inspector General has identified the integrity of Medicare payments as one of the top management challenges facing the Department. The Improper Payments Information Act of 2002, P.L. No. 107-300, requires the head of a Federal agency with any program or activity that may be susceptible to significant improper payments to report to Congress the agencys estimate of improper payments. In addition, for any program or activity with estimated improper payments exceeding $10 million, the agency must report to Congress the actions that the agency is taking to reduce those payments. During our 4-year audit period (FYs 2005 through 2008), CMS used two programs to estimate improper Medicare FFS payments: the Hospital Payment Monitoring Program (HPMP) and the Comprehensive Error Rate Testing (CERT) program. When aggregated, the programs produced an overall improper payment estimate and a paid claim error rate. The reported estimates of improper Medicare FFS payments decreased from $23.8 billion (a 14.2-percent error rate) in FY 1996, the first year that an error rate was developed, to $10.4 billion (a 3.6-percent error rate) in FY 2008. We refer to providers that had at least one error in each of the 4 years of our audit period as error-prone providers.Our objective was to determine whether CMS and its contractors used historical HPMP and CERT error rate data to identify and focus on error-prone providers. CMS and its contractors did not use historical HPMP and CERT error rate data to identify and focus on error-prone providers. Although payment contractors developed corrective actions based on the HPMP and CERT error rate data, they typically did not focus on error-prone providers for review and corrective action.
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