News: GAO calls on CMS to increase consistency among contractors

Recovery Auditors conducted almost five times as many reviews as all other Medicare auditors combined in fiscal year (FY) 2012, according to a July report from the Government Accountability Office (GAO). 

As those who work in the healthcare revenue cycle know, CMS postpayment review contractors were established by different legislative actions, are managed by different CMS offices, and serve different functions. Frequently dubbed the “alphabet soup” of oversight contractors, these entities include Medicare Administrative Contractors (MACs), Zone Program Integrity Contractors (ZPICs), Recovery Auditors, and Comprehensive Error Rate Testing (CERT) contractors.

In its study, the GAO reviewed CMS contracts, requirements for claims’ reviews, and interviewed CMS and provider associations in order to “assesses the extent to which requirements for postpayment claims reviews differ across the contractors,” and to determine whether these differences “could impede effective and efficient claims reviews.”

In essence the GAO did little more than call on CMS to review its own practices and increase consistency where possible. Officially it called on the agency to:

• Examine all postpayment review requirements for contractors to determine those that could be made more consistent
• Communicate publicly CMS's findings and its time frame for taking further action
• Reduce differences in postpayment review requirements