In January, the House and Senate passed an omnibus appropriations bill that President Obama later signed. In addition to approving the spending levels for all domestic discretionary and mandatory spending, the omnibus appropriations bill includes language directing CMS and HHS to undertake various initiatives over the course of the next few months that will potentially impact the Medicare program.
Medicare Fraud Prevention
The spending agreement urges CMS to develop a more robust set of tools to prevent fraud, such as using the latest technology to ensure only valid beneficiaries and valid providers receive benefits. The statement directs the Government Accountability Office (GAO) to review the feasibility, cost, benefits, and barriers for CMS to implement a Medicare transactional system with “smart card” type technology.
The GAO is expected to publish a report within one year of enactment. CMS is expected to provide a report on its plans for implementing the GAO recommendations within 90 days after the GAO report is published.
Recovery Audit Contractors (RACs)
The bill establishes that there are concerns that the Medicare RAC program has created incentives for RACs to take overly aggressive actions against providers. The Report accompanying the bill cites “information received from the Office of Medicare Hearings and Appeals (OMHA) indicates that about 50 percent of the estimated 43,000 appeals were fully or partially overturned at its level.”
The bill directs that the Fiscal Year 2015 budget request should include a plan with a time line, goals, and measurable objectives to improve the RAC process. Finally, CMS is urged to stay focused on improvements to all “operations that prevent improper payments in lieu of chasing dollars after the fact.”
CMS Policy Guidance
CMS uses Medicare Administrative Contractors (MACs) as its agent in lieu of Federal employees to process reimbursement activity. The MACs may develop and implement independent policies (Local Coverage Decisions or LCDs), which can be perceived as being inconsistent with CMS guidance. The Congress has asked CMS to provide a detailed description of the mechanisms CMS has in place, or plans to put in place, to ensure its Contractors consistently adhere to CMS policies.
ADVOCATE will continue to keep you informed on this and all issues impacting your radiology practice.
With best regards,
Kirk Reinitz, CPA