CMS News Center

The Centers for Medicare & Medicaid Services (CMS) has a dedicated online resource center to assist healthcare providers with maintaining their progress related to ICD-10-CM. Among the information being offered is:

• 2017 diagnosis code sets and guidelines;
• health-specific case studies and guides to treatment (including diabetes); 
• post-implementation advice; and
• a contact list for providers seeking answers to Medicare- and Medicaid-related questions. 

For more information, visit www.cms.gov/medicare/coding/icd10/index.html 

Fraud Prevention Helps Gain $42 Billion Medicare Savings 

CMS officials have released a report that claims investments related to “integrity activities,” including the stamping out of fraud and deterring and/or reducing other improper payments, have resulted in significant savings for taxpayers and beneficiaries. From Oct. 1, 2012, through Sept. 30, 2014, every dollar invested into related efforts has saved an average of $12.40 for the program for a total savings of more than $42 billion, officials said. 

According to CMS, these activities have utilized a multifaceted approach ranging from provider enrollment and screening standards to the use of enforcement authorities and advanced analytics, such as predictive modeling. Officials also report their efforts to proactively prevent potentially fraudulent and improper payments from being made, such as moving efforts away from the “pay-and-chase” method of recovering payments after they had already been made, have been increasingly effective. In fiscal year 2013, savings from prevention activities represented about 68% of total savings. In 2014, the portion of savings from preventing potentially fraudulent and improper payments rose to nearly 74%. This development means more taxpayer dollars intended to care for the beneficiaries are not being paid at all, avoiding the need to recover improperly paid amounts from healthcare providers and suppliers, officials said. Preliminary information from 2015 indicates integrity efforts continue to accrue savings of this magnitude and the portion attributed to prevention continues to increase. CMS is expected to release 2015 numbers later this year.