CMS Announces New Demonstrations to Help Curb Improper Medicare, Medicaid Payments Efforts will Build on 2011 Decreases in Medicare, Medicaid Improper Payments
In 2010, the President announced three goals for cutting improper payments by 2012: reducing overall payment errors by $50 billion, cutting the Medicare fee-for-service error rate in half, and recovering $2 billion in improper payments. To help achieve these goals, the Centers for Medicare & Medicaid Services (CMS) has announced it will launch demonstration programs beginning in January 2012 targeting some of the most common factors that lead to improper payments. Cost Saving Projects will Help Protect Medicare and Medicaid Beginning on January 1, 2012, CMS will conduct demonstration projects that will strengthen Medicare by aiming at eliminating fraud, waste, and abuse. Reductions in improper payments will help ensure the sound future of the Medicare Trust Fund and protect Medicare beneficiaries who depend upon it such as: * Recovery Audit Prepayment Review * Prior Authorization for Certain Medical Equipment * Part A to Part B Rebilling This past May, HHS announced a pilot project under the Partnership Fund for Program Integrity Innovation<http://partner4solutions.gov/> to test an automated tool to screen providers for the risk of fraud. Currently, HHS and States lack standardized Medicaid provider data, which hampers detection of potential fraud. If successful, this tool will not only help prevent improper payments by weeding out fraudulent providers, but it will help States focus their resources where fraud is most likely to occur. New Projects Build on 2011 Savings The 2012 projects announced will build on accomplishments in 2011 to reduce Medicare and Medicaid improper payment rates. CMS is also reporting for the first time a composite improper payment rate for the Medicare Part D prescription drug program. The improper payment rate for the Children's Health Insurance Program (CHIP) will not be published until 2012. While improper payment rates are not necessarily an indicator of fraud in Medicare, Medicaid or CHIP, they do provide HHS, CMS and States with a more complete assessment of factors leading to error rates and new ways to help prevent them. CMS is continuing to invest time and resources to work with providers across the country and eliminate errors through increased and improved training, education, and outreach. To read the full CMS fact Sheet is issued click here: http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4176 Additional Fact sheets issued today (11/15/11): CMS Prior Auth Fact Sheet- https://www.cms.gov/apps/media/press/factsheet.asp?Counter=4168 CMS Rebilling Fact Sheet - http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4169 CMS Recovery Audit (RAC) Demo Fact Sheet- http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4170 CMS Medicaid Fact Sheet- http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4171 CMS Medicare D fact sheet http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4172 CMS Medicare C fact sheet and http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4175 CMS Medicare FFS Improper payments Fact Sheet- http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4174 Also, please see the White House Press Release- We Can't Wait: Agencies Cut Nearly $18 Billion in Improper Payments, Announce New Steps for Stopping Government Waste- http://www.whitehouse.gov/the-press-office/2011/11/15/we-can-t-wait-agencies-cut-nearly-18-billion-improper-payments-announce- * Agency improper payment data is being updated Tuesday afternoon at www.paymentaccuracy.gov<http://www.paymentaccuracy.gov> ------------------------------------------------- Each Office Visit is an Opportunity. Medicare patients give many reasons for not getting their annual flu vaccination, but the fact is that flu seasons are unpredictable and can be severe. Each year, it is estimated that 90 percent of seasonal flu-related deaths and more than 60 percent of seasonal flu-related hospitalizations occur in people 65 years and older. Please talk with your Medicare patients about the importance of getting their annual flu vaccination. And remember, vaccination is important for healthcare workers too, who may spread the flu to high risk patients. Don't forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself. Get the Flu Vaccine-Not the Flu. Remember - The flu vaccine plus its administration are covered Part B benefits. CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that the flu vaccine is NOT a Part D-covered drug. For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.cms.gov/immunizations. ------------------------------------------------------ Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. If you know someone who would like to subscribe to a Medicare Fee-For-Service (FFS) provider listserv, go to (http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf). If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv. Please DO NOT respond to this email. This email is a service of CMS and routed through an electronic mail server to communicate Medicare policy and operational changes and/or updates. 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