Tag: GAO

WASHINGTON - The average reduction in payment rates in non-competitive bidding areas for five DME items with the highest expenditures in 2016 was 46%, according to a new report from the Government Accountability Office.In its review of the effects of reduced payment rates in non-bid areas, the GAO also found that: the number of suppliers furnishing rate-adjusted items in non-bid areas in 2016 decreased 8% compared to 2015; and beneficiary utilization of rate-adjusted items in non-bid areas in 2016...

WASHINGTON - The Government Accountability Office agrees that CMS failed to properly assess “potential organizational conflict” when the agency awarded Maximus the DMEPOS QIC contract. The GAO's decision* comes after C2C Solutions, the current QIC contractor, protested the award. The GAO's decision sustains C2C's protest. “Protest that the agency failed to evaluate a potential impaired objectivity organizational conflict of interest is sustained where the awardee's wholly-owned...

WASHINGTON - The Government Accountability Office has recommended that the Department of Health and Human Services evaluates the possible costs and savings of using disposable devices as substitutes for DME and, if appropriate, seek legislative authority to cover them.While Medicare generally doesn't cover disposable devices, the GAO identified eight such devices that could potentially substitute for DME devices that are covered. These disposable devices fall into existing Medicare DME categories:...

WASHINGTON - Concerns over payment and coverage restrictions are barriers to healthcare providers and patients using telehealth and remote patient monitoring to improve quality of care, according to a new study from the Government Accountability Office. An example of such a restriction, the GAO says: Medicare telehealth coverage limits the geographic and practice settings in which beneficiaries may receive these services. For the study, the GAO reviewed Medicare documents and regulations, and interviewed...

WASHINGTON - The number of Medicare beneficiaries receiving DMEPOS in Round 2 areas decreased more than twice as much from 2012 to 2014 than in non-bid areas, according to a new report from the Government Accountability Office.The number of beneficiaries receiving DMEPOS in Round 2 areas decreased 17% from 2012, the year before bid pricing went into effect, to 2014, the year after. The number of beneficiaries in non-bid areas decreased 6% during the same time period.“CMS officials stated that...

WASHINGTON - Accessories for complex power wheelchairs might account for a relatively small share of Medicare utilization, but they account for a much larger share of total spending, according to a highly anticipated report published June 1 by the Government Accountability Office.These accessories accounted for about 18% (312,000) of all wheelchair accessories in 2014 but about 51% ($159 million) of total spending. E1007, a power seating system with combination tilt and recline, accounted for 35%...

WASHINGTON - The Government Accountability Office isn't pleased with CMS's progress in recovering substantial amounts of improper payments from Medicare Advantage organizations. The agency currently uses risk adjustment data validation audits to recover improper payments in the MA program. The GAO found that CMS's methodology does not result in the selection of contracts for audit that have the greatest potential for recovery of improper payments. The GAO also found “substantial delays”...

WASHINGTON - CMS needs to do a better job overseeing Medicaid managed care, the Government Accountability Office says in a report public released June 18.The GAO found that the program integrity units of five states and the Medicaid Fraud Control Units of seven states that were included in its review focus their efforts on Medicaid fee-for-service payments, not Medicaid managed care payments. This, the GAO points out, despite the fact that Medicaid managed care is growing at a faster rate than fee-for-service.Moreover,...

WASHINGTON - Performant Recovery has filed a Government Accountability Office (GAO) bid protest against CMS.The protest, filed Jan. 6, comes on the heels of the agency's announcement that it had selected Connolly as the recovery audit contractor (RAC) to oversee the national program for DME, home health and hospice.Wilton, Conn.-based Connolly is the current RAC for Jurisdiction C, while Performant Recovery in Livermore, Calif., is the contractor for Jurisdiction A.The national program is on...

WASHINGTON - The Government Accountability Office (GAO) is calling on CMS to improve the efficiency and effectiveness of its post-payment review efforts by providing contractors with additional guidance and more oversight.The GAO reviewed MACs, ZPICs, RAs and CERT contractors because “questions have been raised about their effectiveness and efficiency, and the burden on providers.”While CMS has taken steps to prevent contractors from conducting duplicative post-payment claims reviews,...