CMS awards contracts to track incorrect Medicare payments

The Centers for Medicare and Medicaid Services have awarded several contracts to identify and collect Medicare overpayments that claims processors and their systems may have missed. The recovery audit contractors will participate in demonstration projects in California, Florida and New York as part of CMS' effort to increase the accuracy of payments.

CMS, an agency of the Health and Human Services Department, said it is providing clearer guidance on Medicare billing to reduce erroneous payments.

In order to improve accuracy, CMS has also undertaken efforts at contractor reform, supplementary carrier quality controls and improved data capabilities. Medicare accounts for almost half of the $45 billion in improper federal payments annually, a recent report from the Office of Management and Budget said.

The contractors will analyze Medicare claims history and medical records to uncover overpayments, recover the overpayments and be paid a percentage.

'In conjunction with new steps to ensure Medicare's billing rules are clear, this demonstration will let us test a new approach to ensure that payments made to providers are accurate,' said CMS Administrator Mark McClellan.

CMS offers education and training resources such as a customized provider Web site, new Medicare Learning Network guides and Web-based training to help understand new billing procedures.

The recovery audit contractors are:

  • Diversified Collection Services Inc. of Livermore, Calif.

  • Public Consulting Group Inc. of Boston

  • HealthData Insights of Las Vegas

  • Connolly Consulting Associates Inc. of Wilton, Conn.

  • PRG-Shultz International Inc. of Atlanta.



About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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