GAO Scrutinizes Insufficient Documentation as Cause for Improper Medicare and Medicaid Payments

For quite a long time, Medicare and Medicaid have been included on a Government Accountability Office (GAO) rundown of government programs that are at an expanded danger of misrepresentation, waste, misuse, and bungle. GAO’s investigations of FY 2017 program activities that gauges $27.5 billion in inappropriate installments implies it will probably make the rundown again in one year from now’s report.

The GAO is an autonomous, neutral organization that works for Congress. Frequently called the “congressional guard dog,” GAO inspects how citizen dollars are spent and furnishes Congress and government organizations with reports to help survey the administrative government’s execution. As indicated by the report, the GAO appraises that Medicare expense for-administration made $23.2 billion in inappropriate installments while Medicaid made $4.3 billion.

To build up these assessments, CMS utilizes temporary workers to review an example size of cases. The reviews incorporate medicinal documentation audits to approve restorative need and adherence to CMS charging approaches. The contractual workers extrapolate patterns from the examples to extend the by and large ill-advised installment rate.

The report characterizes lacking documentation as “ill-advised installments in which suppliers submit documentation that is inadequate to decide if a case was legitimate, for example, when there is deficient documentation to decide whether administrations were medicinally important, or when a particular, required documentation component, for example, a mark, is absent.”

As per the GAO, inadequate documentation was referred to as the reason for 64 percent of Medicare and 57 percent of Medicaid inappropriate installments. Information from CMS uncovered that the general rate of deficient documentation over all administrations in FY 2017 was 6.1 percent for Medicare versus 1.3 percent in Medicaid. The report concentrated on this difference.

The GAO report likewise incorporates suggestions to CMS for improving the therapeutic audit procedure to all the more likely comprehend the ill-advised installment rate.