GAO Recommends Extending Prior Authorization

The home health care industry rejoiced after the prior authorization demonstration from the Centers for Medicare & Medicaid Services (CMS) was put on hold indefinitely in 2017. However, the Government Accountability Office (GAO) is urging CMS to extend prior authorization across the general health care space, according to a recent report. The payment approach requires health […]

Medicaid Payments Should Depend on Personal Care Data, Congressman Says

To improve the oversight of personal home care services paid for by Medicaid, the solution is simple: Withhold money from states if they do not furnish the data that federal agencies require for monitoring. That was the idea put forward Tuesday by Rep. Chris Collins (R-NY) during a hearing of the Oversight and Investigations subcommittee […]

GAO: Home Health Referral Sources Need Documentation Lessons

Home health agencies that are fed up with referral sources not providing proper documentation have an ally in Washington, D.C.: the Government Accountability Office (GAO). The GAO has elicited a promise that the Centers for Medicare & Medicaid Services (CMS) will begin requiring more education for referring providers about home health documentation. After reviewing oversight […]

GAO: Poor Data Collection Hampers CMS’ Personal Care Oversight

Poor data collection regarding personal care could be making it easier to commit Medicaid fraud, and the Centers for Medicare & Medicaid Services (CMS) should issue guidance to improve the situation, according to a new report from the Government Accountability Office (GAO). There are two main systems through which CMS collects data about Medicaid personal […]

GAO: Medicaid’s Approach to Home Care Needs More Uniformity

Medicaid currently pays for personal care services through a patchwork of different waivers and other programs, with varying standards for ensuring that beneficiaries are kept safe and billing is above-board. This needs to change, according to a newly released report from the federal Government Accountability Office (GAO). To compile its report, the GAO evaluated Medicaid-funded […]

HHS Issues New Rules to Unclog Medicare Appeals Pipeline

After a damning report from the U.S. Government Accountability Office (GAO) on the rising number of Medicare claims appeals and the resulting dramatic backlog of unresolved cases, the latest proposed changes to clear out the backlog have appeared. Medicare Administrative Contractors (MACs) process an estimated 1.2 billion fee-for-service claims on behalf of the Centers for […]

GAO: CMS Lacks Reliable Data, Oversight

The U.S. Government Accountability Office (GAO) has found that the Centers for Medicare & Medicaid Services (CMS) does not have reliable data or sufficient oversight to measure and prevent duplication of postpayment claims reviews.  CMS should provide additional oversight and guidance regarding data, duplicative reviews and contractor correspondence to improve effectiveness and efficiency of postpayment […]