GAO Releases Report Critical of CMS Contractor Process

Earlier this week, the Government Accountability Office (GAO) released a report entitled “Increasing Consistency of Contractor Requirements May Improve Administrative Efficiency.”  Members of Congress pressed GAO to look at issues that have arisen about the efficacy of claim reviews by Medicare contractors, which includes RAC, ZPIC and CERT auditors, as well as the regional MAC’s.

The report states that while the different types of contractors have a similar process for postpayment audits, there are glaring irregularities in the requirements for the different entities. Oversight in which claims are selected, staffing of those reviewing claims, deadlines for providers to satisfy requests for additional documentation and overall communication from contractors to providers about the process and potential penalties for missing certain deadlines. 

The GAO report detailed the above differences and stated that they may impede the effectiveness of claims audit programs. The lack of a clear process, or a clear definition of, which claims are being audited by which contractors, are points that have frustrated providers across the board since the audit programs were accelerated in years past. 

GAO recommends CMS take several actions, although they do not go nearly as far as providers would like, they are atleast attempting to bring some oversight to the independent contractors that are wreaking havoc on orthotic and prosthetic providers billing Medicare. The report notes that the recommendations below are supported by CMS.

1. Examine all contractor postpayment review requirements to determine those that could be made more consistent.
2. Communicate its findings and time frame for taking action.
3. Reduce differences where it can be done without impeding efforts to reduce improper payments.

OPGA will continue to press elected officials and other federal agencies to bring more transparency and legitimacy to Medicare contractors. OPGA parent company, The VGM Group, has developed an Audit White Paper discussing many of the shortcomings of the current system and making potential recommendations to change the program. If you have ideas about other potential solutions to these issues, please contact us directly at or visit


This entry was posted in Orthotics and Prosthetics, re provider, Regulatory, Uncategorized and tagged , , , , , , . Bookmark the permalink.

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