MACs miss performance standards, OIG finds

Friday, January 10, 2014

BATLIMORE – Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS’s performance standards, according to a new report from the Office of Inspector General (OIG).

“Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states.

The OIG based its findings on a performance assessment of 13 MACs conducted from September 2008 to August 2011.

Of the 25% unmet standards, MACs had not resolved issues with 27% of those standards as of June 2012, the report states.

Many of the standards CMS sets for MACs require 100% compliance, but the OIG found CMS did not require action plans in 12% of the unmet standards, leaving those problems four times more likely to go unresolved. 

CMS contractors can earn award fees for performing beyond basic requirements, but the OIG found problems, here, because some troublesome areas highlighted by quality-assurance reviews are not metrics in the award program.

The OIG recommends CMS require action plans for all unmet standards; use reviews to select award fee metrics; meet timeframes for completing quality-assurance reports and award fee determinations; establish timeframes for issuing performance reports; and work with legislatures to increase the time between contract competitions to give CMS more flexibility awarding new contracts.

CMS agreed on all six points, according to the report.