CERT success evident to GAO.
The federal government spent $7 billion less in improper payments in 2005 than in 2004, according to the Government Accountability Office. And this reduction was largely thanks to a reduction in wasteful Medicare spending.
The catch: The GAO says this improvement mostly came from a change in how Medicare estimated improper spending, not from any "improved payment controls."
"When providers do not submit documentation to justify payments received, these payments were counted by [the Department of Health and Human Services] as erroneous," the GAO notes.
But the fact that HHS has made greater efforts to obtain documentation from providers doesn't mean that errors have decreased. Medicare has done a better job of educating providers about the Comprehensive Error Rate Testing program and the importance of responding to questions (see Eli's HCW, Vol. XIV, No. 13).
HHS still blamed Medicare for the biggest part of its improper payments, with an estimated $12.1 billion in waste for 2005.
HHS hasn't yet figured out how to report improper spending in Medicare managed care, according to the GAO's report, "Improper Payments: Agencies' Fiscal Year 2005 Reporting Under The Improper Payments Act Remains Incomplete" (GAO-07-92). • Congress won't be passing a fix for a 2007 physician payment cut this year, experts predict. That likely lets home care off the hook as a source for funding the fix to the 5 percent cut.
But providers shouldn't celebrate their 2007 Medicare rate increase just yet. "The physician payment issue will come up next year if not addressed in the lame duck [session]," cautions the American Association for Homecare.
"Providers should remind Congress to resist any more assaults on home oxygen therapy, home health, and other cost-effective forms of home care during the final weeks of the 109th Congress and next year," AAH urges in a message to members. • Home health agencies that continue to find home health advance beneficiary notices confusing can turn to new resources for help. Regional home health intermediary Cahaba GBA has added two new articles on ABNs to its educational listings for HHAs. "HHABNs and Billing Processes for Denial" and "HHABNs and Reduction in Care" are available at
https://www.cahabagba.com/part_a/education_and_outreach/educational_materials/index.htm under the "Home Health Quick Reference Tools" section. • The Medicaid program should rewrite Medicaid law to encourage the use of home care services, the Medicaid Commission is recommending to law- and policymakers.
The commission, appointed by HHS Secretary Michael Leavitt last year, adopted the suggestions as one of its cost-cutting recommendations for Medicaid, reports The New York Times. The panel next will send a report containing its recommendations to Leavitt. The report will also endorse using managed care plans to coordinate care for the sickest Medicaid beneficiaries.
But Bush administration adversaries [...]
