decisionhealth Newsletters, Part B News - 2002 Issue 5 (May)
GAO: graduated CMS auditing policy is easier on practices' wallets
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Article Overview
This article reviews a GAO report on Medicare claims auditing under CMS, focusing on how the Progressive Corrective Action approach changed medical review intensity, sample sizes, and the use of extrapolation. It is relevant to physicians, practice managers, compliance staff, and coding/billing professionals who follow Medicare audit policy and carrier review activity. The article also discusses findings from selected Medicare carriers and the general accuracy and scope of their review decisions.
Why This Topic Matters
It explains a policy shift that affects how Medicare claims are reviewed and how much practices may have to repay after audits. It is useful for understanding the broader compliance environment for physician billing under Medicare.
What You Will Learn
- How a GAO report characterized CMS Medicare medical review activity
- How the Progressive Corrective Action approach changed audit intensity
- How extrapolation and probe-style review were described at a high level
- What the report said about sample sizes and review frequency
- Which Medicare carriers were included in the GAO review
- What broad findings the report described about review accuracy and carrier criteria
Who Should Read This
- Physicians
- Medical practice managers
- Coding and billing staff
- Compliance officers
- Medicare billing auditors
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