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Q&A: How does CMS calculate improper payments now?


Get your questions answered on CMS and audit criteria.

Q: I understand that the Centers for Medicare and Medicaid Services (CMS) is changing its audit criteria and the way it calculates what it deems to be improper payments. Can you tell me what has changed and what we need to watch out for?

A: You probably are referring to news releases that appeared in November indicating that CMS was doing a better job of calculating "improper Medicare payment rates" in keeping with the Obama administration's goal of more accurate error-rate reporting from all agencies. The release indicated that one of the benefits of this process will be an increased focus on provider education in the areas where "incorrect" fee-for-service claims are submitted. Two of the most vulnerable areas indicated are home health and durable medical equipment (DME).

Going forward, CMS is taking steps to ensure:

Send your practice management questions to mepractice@advanstar.com. The answer to this reader question was provided by Virginia Martin, CPC, CHBC, Healthcare Consulting Associates of Northwest Ohio, Waterville.

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