November 23, 2011
CMS Announces New Demonstrations to Help Curb Improper Medicare, Medicaid Payments
Efforts will Build on 2011 Decreases in Medicare, Medicaid Improper Payments
In 2010, the President announced three goals for cutting improper payments by 2012: reducing overall payment errors by $50 billion, cutting the Medicare fee-for-service error rate in half, and recovering $2 billion in improper payments.
To help achieve these goals, the Centers for Medicare & Medicaid Services (CMS) has announced it will launch demonstration programs beginning in January 2012 targeting some of the most common factors that lead to improper payments.
Cost Saving Projects will Help Protect Medicare and Medicaid
Beginning on January 1, 2012, CMS will conduct demonstration projects that will strengthen Medicare by aiming at eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sound future of the Medicare Trust Fund and protect Medicare beneficiaries who depend upon it such as:
- Recovery Audit Prepayment Review
- Prior Authorization for Certain Medical Equipment
- Part A to Part B Rebilling
This past May, HHS announced a pilot project under the Partnership Fund for Program Integrity Innovation to test an automated tool to screen providers for the risk of fraud. Currently, HHS and States lack standardized Medicaid provider data, which hampers detection of potential fraud. If successful, this tool will not only help prevent improper payments by weeding out fraudulent providers, but it will help States focus their resources where fraud is most likely to occur.
New Projects Build on 2011 Savings
The 2012 projects announced will build on accomplishments in 2011 to reduce Medicare and Medicaid improper payment rates.
CMS is also reporting for the first time a composite improper payment rate for the Medicare Part D prescription drug program. The improper payment rate for the Children’s Health Insurance Program (CHIP) will not be published until 2012.
While improper payment rates are not necessarily an indicator of fraud in Medicare, Medicaid or CHIP, they do provide HHS, CMS and States with a more complete assessment of factors leading to error rates and new ways to help prevent them.
CMS is continuing to invest time and resources to work with providers across the country and eliminate errors through increased and improved training, education, and outreach.
To read the full CMS fact Sheet is issued click here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4176
Additional Fact sheets issued Tuesday (11/15/11):
CMS Prior Auth Fact Sheet- https://www.cms.gov/apps/media/press/factsheet.asp?Counter=4168
CMS Rebilling Fact Sheet - http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4169
CMS Recovery Audit (RAC) Demo Fact Sheet- http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4170
CMS Medicaid Fact Sheet- http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4171
CMS Medicare D fact sheet http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4172
CMS Medicare C fact sheet and http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4175
CMS Medicare FFS Improper payments Fact Sheet- http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4174
Also, please see the White House Press Release- We Can’t Wait: Agencies Cut Nearly $18 Billion in Improper Payments, Announce New Steps for Stopping Government Waste- http://www.whitehouse.gov/the-press-office/2011/11/15/we-can-t-wait-agencies-cut-nearly-18-billion-improper-payments-announce-
- Agency improper payment data is being updated Tuesday afternoon at www.paymentaccuracy.gov
