Improper Payments by Medicare Addressed at NCMS/CMS Meeting

On April 25, 2012, NCMS president Robert Monteiro, MD, and senior NCMS staff met with Melanie Combs-Dyer, Deputy Director, Provider Compliance Group at the Centers for Medicare and Medicaid Services (CMS) to discuss programs aimed at reducing improper payments in the Medicare program. While there are five categories of contractors, each fulfilling different roles in improper payment mitigation for CMS, the majority of this meeting focused on the Recovery Audit Program (RAC) and Zone Program Integrity Contractors (ZPIC). Information about all of these programs can be reviewed here.

The NCMS identified several areas for potential improvement, but emphasized: 1) the need for on-site visits by the contractor performing the audit, 2) the need for an identified contact person who can provide accurate information to the practice regarding the status of an audit, and 3) the general poor quality of communication between the claims processor and audit contractors.

The meeting, which was requested by Ms. Combs-Dyer, represented an unusual opportunity to communicate directly with a senior program administrator from CMS. The NCMS appreciates the opportunity to engage in productive discussions about programs that have a significant impact on physicians in North Carolina.


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