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The Centers for Medicare & Medicaid Services Could Improve Performance Measures Associated With the Fraud Prevention System

We found that CMS's process for refining and enhancing FPS models needs improvement. Specifically, CMS could not track savings from administrative actions back to the individual FPS models that initiated the investigation because, according to CMS, that capability was not built into the FPS. In addition, CMS did not make use of all pertinent performance results because CMS did not (1) ensure that the adjusted savings Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) reported to CMS reflected amounts certified by the OIG and (2) evaluate FPS ...

Enhancements Needed in the Tracking and Collection of Medicare Overpayments Identified by ZPICs and PSCs

This study continues OIG's body of work examining overpayments made by Medicare. Overpayments can be identified by a number of key players including providers and Medicare contractors. Recovering overpayments is critical to reducing improper payments in the Medicare program. Past OIG work found that overpayments referred by program safeguard contractors (PSCs) for collection did not result in significant recoveries to the Medicare program. As of 2012, CMS had transitioned the workload of most PSCs to six zone program integrity contractors (ZPICs). In 2016, CMS began transitioning the remaining PSCs ...

Updated Editing of Always Therapy Services - MCS

This MLN Matters Article is intended for therapists, physicians, and certain other practitioners billing Medicare Administrative Contractors (MACs) for therapy services provided to Medicare beneficiaries. Services furnished under the Outpatient Therapy (OPT) services benefit – including SpeechLanguage Pathology (SLP), Occupational Therapy (OT), and Physical Therapy (PT) – are subject to the financial limitations, known as therapy caps, originally required under Section 4541 of the Balanced Budget Act (1997). Read the entire article