AMA urges CMS to streamline Medicare audits

The American Medical Association is calling on CMS to improve efficiency within the Medicare Recovery Audit Contractor program.

The program aims to identify and correct improper Medicare payments. This involves identifying and correcting overpayments made on Medicare claims as well as underpayments to providers. The program's auditors review claims after they are paid and receive a financial reward for denying hospital claims. They are paid with little focus on the accuracy of denials.

In a letter to CMS Administrator Seema Verma sent Aug. 9, the medical association urged CMS to spend time streamlining the audit program to reduce physician burden, decrease costs and ensure physicians are focused on providing the best care possible.

Physicians said the federal government should allow settlements for Medicare Part B claims to reduce the backlog of Medicare appeals at the administrative law judge level. They also recommended that CMS require auditors to pay the costs (including interest) to physicians who win an audit appeal; penalize auditors who make errors; and eliminate the contingency fee structure of Medicare audits.

The medical association's letter to CMS and recommendations were in response to the federal government's request for input on reducing administrative burden.

Ayla Ellison contributed to this report.


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