Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Healthcare IT Today

JANUARY 17, 2024

The following is a guest article by Ritesh Ramesh, CEO at MDaudit Safeguarding revenues in the coming year requires healthcare systems to proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased AI investments.

Overpayment 126

Overpayment Overpayments Compliance Medicare 126

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). 1395w-23): Medicare Advantage Organizations (MAOs) are paid a base rate by CMS. Risk Adjustment.

Medicare 52

Medicare Medicare Overpayment Overpayments 52

Hall Render

JANUARY 10, 2025

On January 1, 2025, the Centers for Medicare and Medicaid Services’ (“CMS”) new 60-Day Rule became effective. However, under the updated rule, the obligation to report and return an overpayment begins upon identification, even if the exact amount is undetermined. The rule is codified at 42 U.S.C. 1320a-7k(d).

Overpayments 40

Overpayments Overpayment ACA Medicare 40

AIHC

SEPTEMBER 30, 2024

This short article provides a basic overview of this complex topic. Medicare & the OIG are performing Risk Adjustment audits, are you? This was originally mandated by the Centers for Medicare & Medicaid Services (CMS) back in 1997 and implemented in 2004.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

Fraud 72

Fraud Medicare Medicare Overpayment 72

Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. This article covers the essentials of SNF billing compliance, including processes, guidelines, exclusions, and practical tips for providers.

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 52

AIHC

FEBRUARY 17, 2025

This article follows a road less-traveled by discussing the potential of audit managers knowingly skewing audit results causing unintended consequences within what appears to be a well-functioning compliance program. Tons of information can be found on the Internet, books, articles, etc. on fraud detection and prevention in healthcare.

Fraud 52

Fraud Compliance Overpayment Overpayments 52

YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). The inflated charges resulted in inappropriate outlier payments from Medicare.

Compliance 52

Compliance US Department of Health and Human Services Overpayment Overpayments 52

Healthcare IT Today

FEBRUARY 2, 2023

The following is a guest article by Rebecca Darnall, R isk Adjustment Leader at Episource. As proof, several health plans have been making headlines for coding errors and other issues that surfaced during audits: In just the third quarter of 2022, at least four audits have specifically targeted Medicare Advantage plans.

Medicare 69

Medicare Medicare Overpayment Overpayments 69

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

Fraud 52

Fraud Compliance Medicare Medicare 52

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. This information is not all-inclusive and the article is a truncated version of Lesson 3 from our Certified Outpatient Clinical Appeals Specialist (COCAS SM ) training program.

Medicare 52

Medicare Medicare Compliance Governance 52

YouCompli

SEPTEMBER 27, 2023

Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. Since claims are submitted electronically, Medicare and others use a system of claims edits to avoid paying claims inappropriately.

Compliance 52

Compliance Overpayment Overpayments Medicare 52

YouCompli

SEPTEMBER 13, 2023

Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Fraud Compliance 52

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. This ends Part 3 for the denials and appeals article series.

Fraud 52

Fraud Medicare Medicare Compliance 52

Hall Render

DECEMBER 27, 2023

Further, entities should review non-monetary compensation provided in 2023 to ensure that such compensation did not exceed the 2023 limit of $489 and take any necessary corrective action to repay excess amounts within 180 days of the overpayment or by December 31, 2023.

Hospitals 75

Hospitals Overpayment Overpayments Medicaid 75

AIHC

SEPTEMBER 5, 2023

This article is not intended as legal or consulting advice. If your practice is currently using a telebehavioral health approach for patient treatment, or if you organization is considering implementing this approach, we hope this article will give some food-for-thought on the topic. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

YouCompli

OCTOBER 26, 2022

The review found providers often did not meet the Medicare billing requirements – a whopping 83 of 200 were in error. That’s a 41% error rate with an extrapolated overpayment of?$269 Never miss an article from Brian. 269 million.?. The majority of the errors were due to: Incomplete medical record documentation.

Compliance 52

Compliance Compliance Officers Overpayment Overpayments 52

Hall Render

APRIL 18, 2022

CMS plans to increase Medicare reimbursement for SNFs by 3.9% reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare. Hall Render blog posts and articles are intended for informational purposes only. The Public Health Emergency has been in effect since January 27, 2020. in fiscal year 2023.

Public Health 40

Public Health COVID-19 Overpayment Overpayments 40

AIHC

OCTOBER 23, 2024

The information provided in this article is not comprehensive and not intended as consulting or legal advice. Examples of these types of audits would be a Joint Commission, or CMS (Centers for Medicare and Medicaid Services) contractor audit. Corrective action includes refunding overpayments revealed during the audit.

Compliance 52

Compliance Overpayment Overpayments Medicaid 52

Hall Render

NOVEMBER 25, 2024

When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, the claim submission form includes certifications that the claimed services were provided in compliance with all applicable statutes, regulations and rules. Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

AIHC

MARCH 22, 2022

This article provides a basic overview of the importance of improving your appeals process to get denials overturned as it relates to overall revenue cycle management. Monitor Reports for Inappropriate Write-Offs Are accounts reconciled and overpayments identified and handled properly?

Overpayment 52

Overpayment Overpayments Medicare Medicare 52

Hall Render

DECEMBER 6, 2022

As part of the final regulations released by the Centers for Medicare & Medicaid Services (“CMS”) effective January 19, 2021, CMS finalized a new exception for arrangements where an entity pays a physician less than $5,000 over the course of a calendar year in exchange for items or services. New Exception for Limited Remuneration.

COVID-19 40

COVID-19 Hospitals Overpayment Overpayments 40

Hall Render

DECEMBER 11, 2024

The section currently requires OIG to take into account access of beneficiaries to physician services for which payment may be made under Medicare, Medicaid or other federal health care programs in determining whether to impose an exclusion. Hall Render blog posts and articles are intended for informational purposes only.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS states a temporary adjustment is necessary to offset this overpayment. Submission of All-Payer OASIS Data.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

HIPAA Journal

MARCH 30, 2022

Articles discussing the 3 major things addressed in the HIPAA law often tend to focus on the Administrative, Physical, and Technical Safeguards of the Security Rule. billion recovered relating to Medicare fraud alone. In 2021, 97 non qui tam cases were investigated and $3.59 The total recovered in 2021 exceeded $5 billion.

HIPAA 137

HIPAA Fraud Health Insurance Health Care Reform 137

Hall Render

DECEMBER 31, 2024

Further, entities should review non-monetary compensation provided in 2024 to ensure that such compensation did not exceed the 2024 limit of $507 and take any necessary corrective action to repay excess amounts within the earlier of 180 days of the overpayment or by December 31, 2024.

Hospitals 40

Hospitals Overpayment Overpayments Medicaid 40

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 Centers for Medicare and Medicaid Services (CMS) reimbursed states $34.3 billion during the pandemic. In New Jersey, a call for experts in the 60-year-old programming language COBOL was issued to “metaphorically” highlight the age of its systems. billion of that amount.

Medicaid 52

Medicaid Medicaid COVID-19 Overpayment 52

Hall Render

JANUARY 19, 2024

NATIONAL 13 major health systems partner with high schools in $250M Bloomberg initiative Acute Hospital Care at Home data released AI can help identify social determinants of health American Hospital Association Sues Over Updated HIPAA Guidance Bill aims to push price transparency to ASCs Billing for patient messages to clinicians is increasing, study (..)

Nursing Homes 40

Nursing Homes Nurses COVID-19 Hospitals 40