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Medicare Shift To Front-End Payment Reviews Causes Anxiety, But Actual Impact May Be Small

The jury is still out on whether new Medicare pre-payment review efforts will meaningfully reduce procedure volumes and device consumption, but hospital execs and others say that such an outcome is unlikely.

CMS and its contractors are tired of playing catch-up. At least that’s the message of some recent policy announcements shifting auditors’ focus to assessing the legitimacy of Medicare claims prior to payment as opposed to the well-worn practice of waiting until after reimbursement.

The moves take their cue from private insurers who have long pre-reviewed the appropriateness of medical services before agreeing to...

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