Improper Payment Prevention Goals

1.3.2 - Improper Payment Prevention Goals (Rev. 508; Issued: 03-07-14, Effective: 04-08-14, Implementation: 04-08-14) The CMS strives in every case to pay the right amount to a legitimate provider, for covered, correctly coded and correctly billed services, provided to an eligible beneficiary. To achieve the goal of improving provider compliance and lowering the error rate, CMS follows three parallel strategies: • Preventing improper payments through MACs and SMRC evaluation of program vulnerabilities and taking the necessary action to prevent the identified vulnerabilities in the future • Correcting past improper payments through postpayment claim review by the Recovery Auditors • Measuring improper payments and pinpointing the causes of improper payments by calculating service specific, provider type and contractor specific error rates by the CERT contractors