Reinforce use of prepayment edits, GAO says

Monday, December 10, 2012

WASHINGTON – Use of prepayment edits saved Medicare at least $1.76 billion in fiscal year 2010, but they could have saved even more had they been more widely used, according to a new study by the Government Accountability Office (GAO). The GAO found $14.7 million in payments in fiscal year 2010 that were improper and could have been prevented through automated prepayment edits. It also found that more than $100 million in payments that were inconsistent with three selected local coverage determinations (LCDs) could have been identified using such edits. The GAO recommends that CMS take several actions to reinforce its use of prepayment edits, including restructuring some edits, centralizing the implementation of others, and encouraging more information sharing about effective edits.

For more information on the study, click here.