GAO Report Says CMS Creating Payment Delays
Follow up to 2005 report states that CMS decisions have ‘lead to challenges.’
- By David Kopf
- May 21, 2010
A new report from the U.S. Government Accountability Office (GAO), “Medicare Contracting Reform,” says that despite earlier warnings from the GAO, CMS moves to implement Medicare contractor reform have resulted in claims payment delays and other “challenges.”
The report was a follow up to 2005 review of CMS’s implementation of various provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. In the 2005 report, the GAO reported that CMS’s plan to accelerate the transition “could create challenges and was based on estimated costs and savings that were uncertain.” That 2005 report’s suspicions were confirmed in its latest offering.
“While MACs we interviewed generally described CMS’s facilitation steps as helpful, we identified certain agency decisions that led to challenges for the implementation of Medicare contracting reform,” the GAO wrote in its report. “Some of these decisions, for example, caused delays in payments to providers. CMS sometimes, but not always, used lessons learned from MACs and legacy contractors to make midcourse adjustments to decisions that initially led to challenges.”
The full report can be downloaded at http://www.gao.gov/new.items/d1071.pdf.
Other findings from the GAO:
- CMS’s accelerated implementation schedule overlapped with other Medicare initiatives that affected claims processing, such as requiring that providers re-enroll in order to be paid, which resulted in claims payment delays.
- Despite regular workload monitoring of the former contractors during the MAC transitions, CMS gave the MACs inaccurate workload estimates.
- CMS’s total costs and savings to date for Medicare contracting reform are uncertain because CMS does not track and provide information on all related costs and savings.
- Although CMS expected contracting reform to generate substantial savings from reduced spending on administrative functions and savings to the Medicare trust funds due to improved claims review to detect payments that should not be made, as of April 2009, CMS was unable to provide information on total savings.
American Association for Homecare President Tyler Wilson called on Donald Berwick, M.D., the Harvard professor who has been nominated to be the new CMS administrator, to focus on making the Medicare bureaucracy more efficient and to stop making victims out of legitimate homecare providers.
“The shortcomings at CMS are having an impact on the delivery of quality service and products to Medicare beneficiaries,” Wilson said. “It becomes harder for patients, especially in rural areas, to obtain medical equipment if the only provider for miles goes out of business or can no longer offer a product because the government has created an adverse business climate. Today, CMS is off course. If Dr. Berwick is confirmed, we hope he can right the ship.”
David Kopf is the Editor of HME Business.