Joe Carlson
“Are all these audits worth it in the long run?” Brandt said, adding that the first of two GAO reports on the topic is slated for release in early summer.
In total, 54 of the reports received by the committee gave recommendations addressing the audit burden on healthcare providers, including numerous calls for the CMS to simplify and standardize the auditing process and provide better examples of how to document medical necessity for Medicare procedures.
Meanwhile, more than three-quarters of all the comments addressed the related issue of how to reform the system for detecting improper payments.
Numerous providers and insurers suggested that the CMS revise the requirements for how much money insurance companies can spend on administrative overhead, known as the medical-loss ratio, so that payers aren’t penalized for investing in fraud-prevention efforts.
Commenters also said the CMS could allow Medicare beneficiaries at risk of abusing or diverting addictive medications to be restricted to certain providers and have their prescriptions tracked in real time.
Jo-Ellen Abou Nader, senior director of program integrity at Express Scripts, told Modern Healthcare this month that the topic of giving contractors this ability to “lock in” high-risk prescription users has been raised numerous times with the CMS in the past.Read more: