CMS Plans More Site Visits, Will Release Data Sets


The Center for Medicare and Medicaid Services will be making more frequent site visits to Medicare-enrolled providers and suppliers, and will be releasing new data tools as well as data sets on the availability of Medicare, as well as how it’s used in order to better combat fraud.

The more frequent site visits are specifically targeting both providers and suppliers that are located in high-risk areas, that also receive high reimbursements. The CMS is also using new software to better combat invalid and fake addresses, as well as deactivating addresses that have not billed Medicare within 13 months.

More from BNA.com on the new data tools:

The agency released the Moratoria Provider and Supplier Services and Utilization Data Tool. The tool uses ambulance and home health agency paid claims data within CMS systems for Medicare fee-for-service beneficiaries, Agrawal said in a separate Feb. 22 blog post.

For this first release, the data provide information on the number of Medicare ambulance suppliers and home health agencies serving a geographic region, with moratoria regions at the state and county level clearly indicated, as well as the number of Medicare beneficiaries who use one of these services.

In January, the CMS announced a six-month extension of temporary enrollment moratoria for new ambulance providers and home health agencies in certain metropolitan areas within six states—Florida, Illinois, Michigan, Texas, Pennsylvania and New Jersey. The extension applies to new enrollments in Medicare, Medicaid and the Children’s Health Insurance Program and was imposed due to the ongoing risk of waste, fraud and abuse in the affected metropolitan areas .

Responding to the data release, McDermott said, “It is more effective to use data to focus resources on the more compelling geographic areas rather than taking an overbroad approach with national initiatives that may unfairly snare good providers.”

Since data alone cannot prove fraudulent conduct, the CMS “will want to monitor this effort and test its data theories and address any concerns from good health care providers,” McDermott told Bloomberg BNA.

The full blog announcement post can be read on the CMS’ blog.

Photo by catd_mitchell via Flickr CC License

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