Open Recommendations
Recommendation Number | Significant Recommendation | Recommended Questioned Costs | Recommended Funds for Better Use | Additional Details | |
---|---|---|---|---|---|
2 | No | $0 | $0 | Status as of March 31, 2025 | |
Ensure that the adjudication vendor is able to reproduce on demand all necessary data elements used to adjudicate the claims (e.g., DRG, all procedure codes, and drug information). The universe of claims data should be available to BOP on a national scale in a format that allows for thorough analysis and oversight regardless of institution. | |||||
1a | No | $0 | $0 | Status as of March 31, 2025 | |
Move immediately to require all CMS contractors to submit electronic claims. | |||||
1b | No | $0 | $0 | Status as of March 31, 2025 | |
Ensure those claims are properly analyzed and maintained by BOP's adjudication vendor. | |||||
1c | No | $0 | $0 | Status as of March 31, 2025 | |
Enforce existing contract language that requires the adjudication vendor to perform fraud analytics and report any indicators of fraud to the BOP. |