The Centers for Medicare & Medicaid Services has taken steps to prevent contractors from conducting duplicative post-payment claims reviews but lacks reliable data and sufficient oversight and guidance to measure and fully prevent duplication, GAO has said.
It looked at four types of contractors that review provider documentation to ensure Medicare payments are proper and found that CMS has not provided sufficient oversight for the data being reviewed and has not issued complete guidance to contractors on avoiding duplicative claims reviews.
CMS does have some strategies to coordinate internally among relevant offices regarding requirements for contractors’ claims review activities, and the agency also has strategies to facilitate coordination among contractors, such as requiring joint operating agreements between contractors operating in the same geographic area, according to GAO-14-474.
However, it said these strategies have not led to consistent requirements across contractor types or full coordination.
CMS agreed to take actions to improve the efficiency and effectiveness of contractors’ post-payment review efforts, which include providing additional oversight and guidance regarding data, duplicative reviews, and contractor correspondence.
