In case you missed it, there's a new Medicare audit process coming

Share this content:
Emily Mongan
Emily Mongan

We're living in a very newsy time — it seems like every time I check my phone or my Twitter timeline there's some new story breaking. It's a good, albeit crazy, time to be a journalist.

The more connected you are to news sources, whether it's via social media, television news, print publications or various industry resources, the more stories you'll be bombarded with every day.

So it's understandable if this story we ran — about the Centers for Medicare & Medicaid Services revamping its Medicare audit process — slipped under your radar. After all, last week was a busy one in terms of long-term care news. Sabra's merger with CCP was approved, CMS made some major cuts to its bundled payment models, and hospice providers have a brand new Compare website to worry about.

So if you missed the audit story, here's what you need catch up on: CMS knows that it has a bit of an improper payment problem, and that the way Medicare Administrative Contractors currently review claims now “can be burdensome to providers.”

The solution? A new “targeted probe and educate medical review strategy,” introduced last week, based on a pilot program launched in 2014. The idea is that MACs will single out claims for services that post the most financial risk to Medicare, or those with a high national error rate. The MACs will focus solely on providers “who have the highest claim error rates or billing practices that vary significantly out from their peers,” CMS said.

That focus on less-than-perfect providers will lessen some of the burden on those who are already submitting compliant claims, according to the agency. (A more in-depth flow chart on the process can be seen here.) CMS is aiming to expand the new process to all MAC jurisdictions before the end of this year.

"Overall this looks like an improvement over the existing system," Michael Munger, M.D., president-elect of the American Academy of Family Physicians, told Modern Healthcare. Ronald Hirsch, M.D., with R1 Physician Advisory Services, also noted that the new process “takes the pressure off folks that are doing everything right."

For providers who may not be doing everything right, the process includes an education track to help improve their billing practices. And if you're one of those who prides themselves on exemplary billing, relax. The new audit process will take some of the weight off your shoulders so you can focus more on everything else that's going on in the world right now.

Follow Staff Writer Emily Mongan @emmongan.


Next Article in Daily Editors' Notes

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.