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GAO Calls for Greater Oversight of Medicare Claims Review

The Government Accountability Office (GAO) has released a report recommending that the Centers for Medicare & Medicaid Services (CMS) increase oversight of the Medicare claims review process.

The GAO report responds to questions about the efficiency and effectiveness of the post-payment process, in which multiple audit contractors review the same claims. Some contend the duplicative reviews unduly burden providers.

Four types of contractors now review providers’ claims documentation in the context of processing and payment, potential fraud, improper payments, and annual improper payment reviews. CMS previously took steps to prevent duplicative reviews, but does not have reliable data or sufficient guidance to measure and prevent duplication. CMS created a database for contractors to track review findings, but the GAO found that contractors have not used the database effectively.

The GAO also recommended CMS release additional guidance for contractors to increase efficiency and reduce duplicative reviews of claims. Contact Xiaoyi Huang, JD, director of policy, at xhuang@essentialhospitals.org or 202.585.0127, with questions.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.

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