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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

GAO: Differences in Medicare Contractor Requirements Exacerbate Provider Burden, Inefficiencies

August 30, 2013 | Uncategorized | Comments
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The Government Accountability Office (GAO) has issued a new report highlighting the numerous and varied requirements of Medicare’s contractors for post-payment review, including Medicare Administrative Contractors (MACs); Zone Program Integrity Contractors (ZPICs); Recovery Auditors (RA); and Comprehensive Error Rate Testing (CERT) contractors.

The report, entitled “Medicare Program Integrity: Increasing Consistency of Contractor Requirements May Improve Administrative Efficiency,” found that the extent of CMS’ requirements for the four types of Medicare contractors vary widely, noting that “some of these differences may impede efficiency and effectiveness of claims reviews by increasing administrative burden for providers.”  For example, there are differences in oversight of claims selection, time frames for providers to send in documentation, communications to providers about the reviews, reviewer staffing, and processes to ensure the quality of claims reviews. These differences have, in some cases, impeded providers’ ability to understand and ultimately comply with the various requirements.

The report also includes GAO’s recommendations for CMS, including that CMS examine all Medicare contractor post-payment review requirements to determine those that could be made more consistent; communicate its findings and time frame for taking action; and reduce differences where it can be done without impeding efforts to reduce improper payments.

The National Council applauds the GAO’s recommendations as the proliferation of well-intended yet extraordinarily complex fraud control efforts have sown confusion and difficulty for behavioral health organizations.