On November 15, 2011, CMS announced three demonstration projects to strengthen Medicare by reducing fraud, waste, and abuse.
- Part A to Part B Rebilling—At present, when a contractor makes a determination that an inpatient claim should have been billed as outpatient, the claim is denied in full. This demonstration program will allow the hospital to rebill for 90 percent of the Part B payment if the Medicare contractor or auditor determines that the patient met the requirements for Part B services but did not meet the requirements for a Part A inpatient stay. This program went into effect on January 1, 2012, at a representative sample of 380 hospitals nationwide.
- Prior Authorization of Power Mobility Devices—This program will require Medicare beneficiaries to obtain prior authorization for scooters and power wheelchairs to ensure that their medical condition warrants that device. The program was scheduled to be implemented in the seven states that currently have a high population of fraud- and error-prone providers. Due to the comments the CMS received after announcing this program, implementation has been delayed until further notice.
- Recovery Audit Prepayment Review—Currently, recovery audit contractors review claims after they have been paid. This program, which would allow RACs to review certain types of claims before payment in order to ensure that the provider has complied with Medicare requirements, was scheduled for implementation in 11 states. Due to the comments that CMS received, this program will also be delayed until further notice.