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GAO Confirms Payment Delays to Medical Equipment Providers; Questions Arise as to Whether Medicare Can Implement Reforms
Date:5/18/2010

ount);s.linkTrackVars='prop5,eVar3,prop15';s.prop5='External Link';s.eVar3=s.prop5;s.prop15='94167684';s.tl(this,'o','ExternalLink');" target='_blank' href="http://www.gao.gov/new.items/d1071.pdf">http://www.gao.gov/new.items/d1071.pdf) found an abundance of claim denials under appeal that resulted in long delays in the government paying legitimate providers.  For example, the report said that one new claims contractor "originally planned on receiving 15,000 appeals cases but actually inherited 46,500 cases, which led to processing backlogs and delayed payments to providers." Further confirming the problem, the GAO wrote that "CMS underestimated the number of appeals" being reviewed in its system.

The purpose of the GAO report was to gauge how well CMS is implementing a reform of its claims-processing contractors that Congress ordered back in 2003.  But the GAO exposed unrealistic expectations on the part of CMS, flaws in the reform process, and an inability of CMS to even confirm whether it can achieve the major goal set out for the reforms – a net savings to the Medicare program.    

"Although CMS expected contracting reform to generate substantial savings from reduced spending on administrative functions and savings to the Medicare trust funds due to improved claims review to detect payments that should not be made, as of April 2009, CMS was unable to provide information on total savings," the report states. "CMS provided some information on savings due to reductions in operational spending, but the extent to which these savings were attributable to contracting reform is uncertain. CMS did not track or provide information on savings to the Medicare trust funds due to reduced improper payments related to contracting reform activities."

To be sure, the report raises questions as to whether CMS, as currently co
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SOURCE American Association for Homecare
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