On Friday, May 13, the Government Accountability Office (GAO) publicly released a new Medicare report entitled, “Claim Review Programs Could Be Improved with Additional Prepayment Reviews and Better Data,” which it shared with the Congress and the Centers for Medicare & Medicaid Services (CMS) in April. The report is addressed to the Senate Finance Committee Chairman Orrin Hatch (R-UT) in response to his request. The Report examines: 1. The differences, if any, between prepayment and post-payment reviews, and the extent to which the contractors utilize these types of reviews; 2. The extent to which the Medicare claim review contractors focus their reviews on different types of claims; and 3. CMS’s cost per review and the amount of improper payments identified by the claim review contractors per dollar paid by CMS. In compiling the Report, the GAO reviewed Administration documents, interviewed CMS officials, Recovery Auditors (RAs), and Medicare Administrative Contractors (MACs). The GAO also interviewed representatives from 10 Medicare provider/supplier organizations that have experienced claim reviews on both a pre- and post-payment review basis. The AAA worked the GAO by participating in a telephone interview and providing written comments. The GAO examined three types of contractors – the RAs, the MACs,…

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