CHA News Article

GAO Urges More CMS Oversight and Guidance for Medicare Claims Reviews

The Government Accountability Office (GAO) released a report yesterday recommending the Centers for Medicare & Medicaid Services (CMS) increase its oversight of the Medicare claims review process and provide additional guidance for contractors to improve both the efficiency and effectiveness of reviews. The GAO determined that CMS does not have sufficient information to determine whether its contractors are conducting inappropriate duplicative claims reviews and made four specific recommendations to CMS, including monitoring the Recovery Audit Data Warehouse for accuracy and completeness; providing clear and specific guidance to contractors about duplicative reviews; regularly assessing whether contractors are complying with CMS requirements for the content of correspondence sent to providers about claims reviews; and clarifying and standardizing current requirements for the content of contractors’ additional documentation requests and results letters.