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GAO: Better Consistency in Medicare Payment Review Requirements Could Increase Efficiency

In an August 22 report, the Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid Services (CMS) increase consistency in contractor postpayment review requirements. CMS contractors conduct postpayment reviews on Medicare fee-for-service claims to determine if the claims meet Medicare coverage and payment requirements. The report described the four types of postpayment review contractors CMS uses and evaluated the differences among review process requirements for each. GAO recommended that CMS examine these requirements, determine which could be made more consistent, communicate its findings, and reduce differences among requirements if doing so does not interfere with efforts to reduce improper payments. The Department of Health and Human Services (HHS) agreed with these recommendations in its comments and said CMS is examining the requirements.


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