Roger Steven

United States

Posted in on July 22, 2014

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Overview: The Centers for Medicare & Medicaid Services (CMS) implemented several initiatives to prevent improper payments before CMS processes a claim, and to identify and recover improper payments after processing a claim. The overall goal is to reduce improper payments by identifying and addressing coverage and coding billing errors. The Government estimates that about 8.5 percent of all Medicare Fee-For-Service (FFS) claim payments are improper.

It is difficult to prevent all improper payments considering that the Medicare FFS program processes more than 1 billion claims each year. The CMS uses the Recovery Audit program to detect and correct improper payments in the Medicare Fee for Service (FFS) program and provide information to CMS and review contractors that could help protect the Medicare Trust Funds by preventing future improper payments.

Medicare Recovery and Claim Review Programs