The Centers for Medicare & Medicaid Services (CMS) announced two three-year demonstrations originally scheduled for January 1, 2012 will now begin on or after June 1. Both projects are aimed at reducing improper Medicare payments and eliminating fraud, waste and abuse from the system.
The first program will allow Medicare recovery audit contractors (RACs) to perform prepayment review in 11 states – seven with high levels of fraud or error (FL, CA, MI, TX, NY, LA and IL) and four with the highest number of short hospital stays (PA, OH, NC and MO). When CMS originally announced this program, it indicated that the prepayment review would begin by looking at claims for short inpatient hospital stays.
The second demonstration program will require prior authorization for power mobility devices for beneficiaries with addresses in seven states (CA, FL, IL, MI, NY, NC and TX). CMS made a number of changes to this demonstration in response to concerns, including eliminating an initial prepayment review phase of the demonstration.
HMS will continue to follow developments regarding the implementation of these demonstrations. The Medical Group Management Association (MGMA) has expressed concern over their development and implementation without careful consideration of their effect on physicians, group practices and the patients they serve.
CMS’ statement of support for these programs can be viewed by clicking here.