GAO: Clean up claims reviews

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Government investigators claim — and the Centers for Medicare & Medicaid Services concurs — that more consistency is needed with Medicare post-payment claims reviews.

A new Government Accountability Office report says the number of different rules and procedures for Zone Program Integrity Contractors, Medicare Administrative Contractors, Recovery Audit Contractors and Comprehensive Error Rate Testing Contractors is confusing. For example, providers have 30 days to respond to an Additional Documentation Request (ADR) sent by a ZPIC; 45 days to respond to one sent by a MAC or RA; and 75 days to respond to a CERT contractor, according to the report.

The Department of Health and Human Services agreed with the GAO's recommendations and noted that CMS had begun an examination of its requirements for post-payment claims reviews. 

HHS agreed to examine whether requirements could be standardized across contractor types and to consider standardizing ADR response timeframes.


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