CMS Solicits Comments on the Future of Medicare Program Integrity

October 22, 2019


As a follow-up to the recently released Presidential Executive Order on Medicare, the Centers for Medicare and Medicaid Services (CMS) released two requests for information (RFIs) on the future of Medicare program integrity. For CMS, the focus of Medicare program integrity efforts is on paying the right amount, to legitimate providers and suppliers, for covered, reasonable, and necessary services provided to eligible beneficiaries while taking actions to eliminate fraud and abuse. Through these RFIs, CMS is seeking input on improving the processes currently in place to protect the integrity of the Medicare program. These RFIs are consistent with the Administration’s previously stated priorities of “combating waste fraud and abuse” as well as “removing regulations that create inefficiencies.”

The Using Advanced Technology in Program Integrity RFI is intended to obtain input on how the agency can better use emerging technologies such as artificial intelligence to ensure proper claims payment, reduce provider burden, and overall how to conduct program integrity activities more efficiently.

The Future of Program Integrity RFI focuses on program integrity value-based purchasing (VBP) programs. CMS seeks specific input on prior authorization, provider education and program integrity for VBP programs.

Comments for both RFIs are due on November 20, 2019.

CMS Hosts Provider Compliance Focus Group on November 12, 2019

Related to the release of these RFIs, the CMS, Center for Program Integrity (CPI) is hosting a focus group for providers to discuss Medicare Fee-for-Service (FFS) compliance topics. Interested parties can participate in-person or via Webex. The mandate of the CPI is to detect and combat fraud, waste, and abuse of the Medicare and Medicaid programs.

The focus group will take place on November 12, 2019, from 12:00-4:00 PM ET. Registration is required for this event and will close on Monday, November 4, 2019. Registration and additional event information can be found here.

The goal of this focus group is to discuss how to streamline the reporting and claims auditing processes. CMS states it is interested in hearing from all providers, billing specialists, suppliers and associations about best practices within the Medicare FFS program and how CMS can improve communication and eliminate any unnecessary requirements.

More information about the Medicare FFS program can be found here.



For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459/ or Mara McDermott at 202-204-1462/

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