G2 News-At-A-Glance: GAO Recommends CMS Standardize Contractor Audit Requirements

The administrative burden and costs associated with providers responding to the various Centers for Medicare and Medicaid Services (CMS) contractors could be reduced if CMS minimizes the differences in postpayment reviews between contractors, concludes a new report. The report, “Medicare Program Integrity: Increasing Consistency of Contractor Requirements May Improve Administrative Efficiency” (GAO-13-522), describes four contractors that conduct post-payment audits or reviews and delineates the existing similarities and differences between them. It also recommends changes CMS could make to accomplish the standardization. CMS concurred with the report’s recommendations and agreed to take steps to reduce differences in post-payment review requirements. The four types of contractors covered by the report are Medicare Administrative Contractors, which process and pay claims; Zone Program Integrity Contractors, which investigate potential fraud; Recovery Auditors, which identify potential fraud on a post-payment basis; and Comprehensive Error Rate Testing contractors, which determine the national Medicare fee-for-service improper payment rate. Representatives of three provider associations interviewed for the report said some of the differences in the contractors’ post-payment claims review requirements can impede effectiveness and efficiency of the claims reviews by complicating providers’ responses to additional documentation requests or their understanding of claims review decisions.