Make CMS audits less burdensome, providers urge lawmakers

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CMS clarifies long-term care quality review in managed care models
CMS clarifies long-term care quality review in managed care models

The Centers for Medicare & Medicaid Services could take a variety of steps to make audits less burdensome, healthcare providers stated in white papers submitted to members of the Senate Finance Committee. The committee released a report Thursday, summarizing stakeholders' input and recommendations for improving the audit process.

A bipartisan group of six senators on the Finance Committee solicited the white papers from providers, insurers, contractors and suppliers in May 2012. The senators' solicitation letter said “the collective wisdom and accumulated insights of thousands of professionals” could provide better ways to combat Medicare and Medicaid fraud and abuse. Nursing home provider advocates have been among those loudly protesting what they see as over-reaching audits.

The senators received more than 160 white papers; about half came from providers. Of these, 47% came from non-hospital providers and provider associations, health systems or insurers.

Audit burden was one of the most frequently addressed issues. Among the white papers that brought up this topic, 74% called for changes to the audit process. Recommendations included increasing communication between providers and CMS during the audit process, requiring audit contractors to communicate electronically with providers rather than through standard mail, and paying interest to providers when appealed denials are overturned. Providers also called for changing the incentives for auditors, who are paid a percentage of recovered funds. More auditor education is also needed, some providers said, particularly on medical necessity criteria.

Half of the white papers that addressed audit burdens recommended simplification measures, such as standardized forms for documenting medical necessity. Many providers also argued that audit contractors should better coordinate with each other to reduce duplicative documentation requests and inconsistent application of policies.

The lawmakers who issued the report, including Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT), said they will work with officials from a variety of agencies to develop potential administrative and legislative actions based on these recommendations.

Click here for the full report.