GAO Shows Improvement Needed to Reduce Improper Billing

Dianne De La Mare

The US Government Accountability Office (GAO) has released a report, Oversight of Efforts to Reduce Improper Billing Needs Improvement, that recommends CMS improve Medicare Administrative Contractor (MAC) oversight by:

1) requiring sufficient detail in MAC reporting to determine the extent to which MACs’ provider education department efforts focus on vulnerable areas;
2) requiring MACs to work together to educate referring providers on proper documentation for DME and home health services; and
3) establishing performance metrics for future probe and educate reviews.

The US Department of Health and Human Services (HHS) has concurred with all of the GAO’s recommendations.