General Overview

7.1.1 - General Overview (Rev. 599, Issued: 06-26-15, Effective: 12-07-15, Implementation: 12-07-15) The annual Improper Payment Reduction Strategy (IPRS) is a problem-focused, outcome-based operational plan developed by the Medicare Administrative Contractor (MAC) that identifies risks to the Medicare Trust Fund and describes the improper payment interventions to be implemented to ensure proper payments and address the risks. The IPRS addresses both provider and service-specific vulnerabilities and includes a prioritization of the problems based on data analysis findings and the availability of resources. Specifically, the IPRS details: • Identified medical review (MR) prioritized problems • Data analysis for each prioritized problem • All MR activities, provider outreach & education (POE), and other improper payment interventions focused on the prioritized problems • Measureable and achievable improvement goals for each prioritized problem • Evaluation methodology for the planned goals and improper payment interventions • Quality assurance activities • Workload and staffing detail • Program management information