Viewing entries tagged prepayment
In any financial transaction, the person holding the money is at an advantage. Getting money back from someone who should not have been paid is harder than not making the payment in the first place. CMS knows this, and that is why it is placing a new emphasis on prepayment review of claims. Originally slated to begin on January 1, 2012 the prepayment review initiative will now formally launch in June. The number of prepayment reviews is going to increase from 1.2 million to 2.7 million claims per year.
There is a large amount of taxpayer dollars at stake. In 2011, the Medicare fee-for-service improper payment rate was 8.6 percent, or $28.8 billion in estimated erroneous claims payments. Medicaid adds another $21.9 billion.
During 2011, CMS recovered $5.6 billion in fraudulent payments, an increase of 167 percent over 2008. The increase in recoveries is attributable in major part to the $350...
Tags: anesthesia, anesthesiologist, anesthesiology, claims, cms, fraud, medicare, physician, prepayment, providers, reviews, tony mira