News: Proposed rule to give auditors more leeway

Auditors could be able to extrapolate findings to larger pools of claims, according to a CMS proposed rule. An auditor could pull 30 claims, find a total overpayment of $1,000, which would mean an average of $33.33 per claim, and then extrapolate those findings to the larger group of 10,000 claims to say that the overpayment was nearly $350,000, RAC Monitor reported.

If finalized, the proposed changes to the audit system would result in an estimated $4.5 billion savings to the Medicare Trust Funds over 10 years, according to the CMS release.

Additionally, the proposed rule included updates to Star Ratings methodology to include new measures for both Medicare Advantage (MA) and Part D, related to controlling high blood pressure, Medicare Plan Finder price accuracy, and all-cause readmissions. CMS would begin collecting data for those measures beginning in 2020 for plan year 2022, FierceHealthcare reported.

The telehealth provisions included the proposed rule could also have ramifications for CDI professionals given previous telehealth documentation deficiencies. The proposals would allow plans to offer telehealth benefits to all members whether they live in rural or urban areas starting in 2020, HealthLeaders Media reported. The current Medicare telehealth benefit has geographic restrictions.

“I am especially excited about proposed changes to allow additional telehealth benefits,” said CMS Administrator Seema Verma in a statement. These changes, according to Verma, “will promote access to care in a more convenient and cost-effective manner for patients.”

Editor’s note: To read the CMS release about the proposals, click here. To read Verma’s statement, click here. To read HealthLeaders Media’s coverage of this story, click here. To read FierceHealthcare’s coverage of this story, click here. To read RAC Monitor’s discussion of claims extrapolation, click here. To read about past telehealth documentation deficiency findings, click here.