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CMS releases new 2017 rates for Medicare health and drug plans

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CMS releases new 2017 rates for Medicare health and drug plans

The public now has the chance to look at two new government data records focusing on ambulance and home health care agencies providing medical services to those on Medicare and through Medicaid.

The Centers for Medicare & Medicaid Services (CMS) released data to inform the public, strengthen those services within communities and to fight Medicare fraud, according to a public press release from Dr. Shantanu Agrawal, CMS Deputy Administrator and Director for the Center for Program Integrity.

One of the public data files provides the public with information about ambulance and home health agencies available to Medicare beneficiaries. The second list shows all those providers and suppliers approved for Medicare’s fee-for-service operations.

Releasing the lists is the outcome of a long-term agency effort to reduce fraud and waste within the Medicare and Medicaid system, according to officials.

“CMS believes the release of the enrollment data provides a clear and transparent way for providers, suppliers, state Medicaid programs, private payers, researchers, and other interested individuals or organizations to leverage Medicare Provider Enrollment information,” the press release said.

Current numbers regarding health care spending are hard to come by. According to The Economist, Americans spent $2.7 trillion a year in 2014 with $415 billion spend through Medicaid programs and $600 billion spent under Medicare programs. There aren’t any concrete numbers regarding how much of that is fraud or waste, but former CMS head Donald Berwick and Andrew Hackbarth of the RAND Corporation said in 2012 that fraud and the actions to combat it cost the government health systems as much as $98 billion.

Additionally, there were more than 2,000 health-fraud investigations on the desks of federal prosecutors at the end of the year in 2013. Approximately $4.3 billion was recovered, according to statistics.

One area where abuse seemed to run rampant was in durable medical kits and home visits. Fraud included charges for visits that never happened to give insulin injections to patients who never received them.

The number of Medicare billings made abuse easy between 2012 and 2014. In 2014, numbers to The Economist show there were 4.5 million claims processed every day.

The CMS press release stated the Affordable Care Act allowed CMS new ways to combat defrauding the Medicare-Medicaid system. One of the moves the agency made was to initiate a series of moratoriums that stopped new home health agencies and ground ambulance suppliers from enrolling to provide services to beneficiaries in certain areas.

The reason, according to CMS officials, was to seriously look at existing providers and suppliers and to focus on ways to find and prevent fraud in regions where it was prevalent. Areas that were targeted included large, metropolitan areas that appeared to be the centers of Medicare-Medicaid abuse schemes.

The result was 17,000 providers lost their license to bill Medicare. Other suppliers, totaling in the thousands, quit as providers to Medicare and Medicaid after CMS required them to get accredited and post $50,000 in surety bond before being approved.

The agency also used the time to gather data on approved agencies and put them into a manageable list the public can understand, according to CMS.

Transparency about providers and suppliers is one way CMS believes it will strengthen program integrity, according to the release. The agency believes releasing more information about approved providers and suppliers will do more to support those serving Medicare patients. While the first list concentrates on approved ambulance and home health care providers, CMS is also released a second list, called the Public Provider Enrollment Files, revealing details regarding all providers and suppliers in Medicare’s fee-for-service programs.

The list includes individual and organization enrollment information on all those providing services and supplies across the country who are approved to bill Medicare. The information also shows reassignment connections between people and groups. The information will be updated quarterly by providers and suppliers giving new information to enrollment information.

CMS states the eventual goal is to get more data on providers and combine it with other public lists within the government. There are at least three other lists that government officials pull from for information.

Both data sets are available at https://data.cms.gov.

Those interested in a fact sheet on the Ambulance and HHA data set, can visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-22.html The utilization tool is available through the CMS website at: https://data.cms.gov/moratoria-data
Those wishing to view a fact sheet on the Public Provider Enrollment file, should visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-22-2.html
This data set is available through a series of .csv files that will be updated quarterly and published at https://data.cms.gov/public-provider-enrollment.
Questions regarding the Public Provider and Supplier Enrollment files or the Ambulance and HHA data set should be sent to the Office of Communications at the Office of Communication, 7500 Security Blvd., Baltimore, MD 21244-1850.

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