Healthcare IT Today

NOVEMBER 22, 2022

The following is a guest article by John Wallace, PT, OCS, Senior Vice President of RCM at WebPT. The payer could also recoup the overpayments from future visits. . When it comes to the number of patients providers can see in a day, some might think that more is more.

Overpayments 111

Overpayments Overpayment Medicare Medicare 111

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.

Overpayments 126

Overpayments Overpayment Compliance Medicare 126

Hall Render

JANUARY 10, 2025

Background CMSs 60-Day Rule is a regulation under the Affordable Care Act (“ACA”) that requires health care providers and suppliers to report and return identified Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply can result in liability under the FCA. The rule is codified at 42 U.S.C.

Overpayments 40

Overpayments Overpayment ACA Medicare 40

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 Overpayments Overpayment 52

AIHC

SEPTEMBER 30, 2024

This short article provides a basic overview of this complex topic. First, although most of the diagnosis codes that EmblemHealth submitted were supported in the medical records and therefore validated 860 of the 1,222 sampled enrollees’ HCCs, the remaining 362 HCCs were not validated and resulted in overpayments.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

The Health Law Firm

OCTOBER 10, 2012

million overpayment demand, according to the Nashville Business Journal. To see the Nashville Business Journal article on the lawsuit, click here. Back in March of 2010, the Nashville ambulance company sued the DHHS after being sent a $2.65 Mammoth Fine Came from Error Rate Extrapolation Formula.

US Department of Health and Human Services 40

US Department of Health and Human Services Overpayments Overpayment 40

Health Care Law Brief

MAY 11, 2022

Covered employers will be tasked with determining eligibility for the bonuses and will be required to track the number of hours worked by covered workers during the vesting periods and, as applicable, the number of patients served by the employer who are eligible to receive services under Article 5, Title 11 of the New York Social Services Law.

Medicaid 97

Medicaid Medicaid Overpayments Overpayment 97

YouCompli

FEBRUARY 22, 2023

They found the facility correctly billed 17 of the 120 but incorrectly billed the remaining 103 claims, which totaled over $580,000 in overpayments. Return illegitimate reimbursement and overpayments quickly. The government has a 60-day overpayment rule. In this case, the OIG audited a sample of 120 outlier payments.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

Health Care Law Brief

APRIL 3, 2023

We note that there are variations of this formula for local and regional plans, which are outside the scope of this article. In the Advance Notice, CMS predicted that the changes to the risk scores and HCC updates will help prevent overpayments by improving the accuracy of payments made to MAOs. Risk Adjustment. See 88 Fed. 6643 (Feb.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

FEBRUARY 2, 2024

The following is a guest article by Tom Magnotta, COO & President at Apixio Albert Einstein famously said , “Whoever is careless with the truth in small matters cannot be trusted with important matters.” This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected.

Payment Systems 78

Payment Systems Overpayments Overpayment Medical Billing 78

Medisys Compliance

NOVEMBER 26, 2024

This article covers the essentials of SNF billing compliance, including processes, guidelines, exclusions, and practical tips for providers. Common Issues Impacting SNF Billing Compliance Improper Payments: Errors in coding or documentation can lead to overpayments or denials. What is SNF Billing Compliance?

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 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 Overpayments Overpayment Medicaid 75

Healthcare IT Today

FEBRUARY 2, 2023

The following is a guest article by Rebecca Darnall, R isk Adjustment Leader at Episource. At $1,000 per code, these errors pointed to a possible overpayment of $64,000 for the identified members. You don’t have to be a fortune teller to see the future of auditing at the Office of Inspector General (or OIG).

Medicare 69

Medicare Medicare Overpayments Overpayment 69

YouCompli

MAY 17, 2023

In this article she discusses relationships and collaboration with other key risk assurance functions. In a previous article, I discussed relationships with operational areas such as Nursing Revenue Cycle, and IT. We further identified overpayments and developed a plan to refund. Care is delivered by humans.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 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 Overpayments 72

YouCompli

SEPTEMBER 27, 2023

 She also claimed the hospital failed to reimburse payors for overpayment stemming from these improperly coded claims. Get the latest from healthcare compliance experts  Never miss an article from CJ Wolf. Sign up to receive YouCompli’s weekly blog article email if you haven’t already.  

Compliance 52

Compliance Overpayments Overpayment Medicare 52

Hall Render

AUGUST 1, 2024

Background The FCA allows private individuals (relators) to bring qui tam lawsuits for fraudulent claims resulting in federal overpayments. Hall Render blog posts and articles are intended for informational purposes only. This ruling is expected to have significant and lasting effects on FCA cases and the imposition of treble damages.

Overpayments 40

Overpayments Overpayment Governance 40

Hall Render

AUGUST 1, 2024

Background The FCA allows private individuals (relators) to bring qui tam lawsuits for fraudulent claims resulting in federal overpayments. Hall Render blog posts and articles are intended for informational purposes only. This ruling is expected to have significant and lasting effects on FCA cases and the imposition of treble damages.

Overpayments 40

Overpayments Overpayment Governance 40

Medisys Compliance

MARCH 7, 2022

In this article, we shared some basic guidelines and recent trends in medical audits and what providers can expect in such payer coding audits. In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first. What just happened? How could they do this?

Medical Billing 52

Medical Billing Medical Billing Outsourcing Overpayments Overpayment 52

YouCompli

FEBRUARY 1, 2023

Among the compliance activities involved are making sure staff are educated on how to Protect patient confidentiality Return overpayments to patients Follow a compliance workplan for monitoring and auditing Document and benchmark audit data 6. Never miss an article from YouCompli.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

Hall Render

AUGUST 4, 2023

CMS described the increase as a “parity adjustment recalibration,” noting that it had previously overestimated overpayments to nursing homes, which resulted in an unintended reduction in reimbursement in 2023. Hall Render blog posts and articles are intended for informational purposes only.

Hospitals 40

Hospitals Overpayments Overpayment Nursing Homes 40

YouCompli

OCTOBER 26, 2022

That’s a 41% error rate with an extrapolated overpayment of?$269 Never miss an article from Brian. In June 2019, the Office of the Inspector General (OIG) released findings and recommendations from a review of polysomnography [sleep] studies. 269 million.?. He is the author of The Healthcare Auditor’s Handbook and Ready, Set, Comply!:

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

NOVEMBER 1, 2023

As a result, the department now has to refund several thousand dollars in overpayments and implement a corrective action plan. He is writing a series of articles on compliance culture for the YouCompli blog. This post looks at building trust among your colleagues.

Compliance 52

Compliance US Department of Health and Human Services Compliance Officers Overpayments 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

APRIL 18, 2022

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. CMS plans to increase Medicare reimbursement for SNFs by 3.9% in fiscal year 2023.

Public Health 40

Public Health COVID-19 Overpayments Overpayment 40

YouCompli

DECEMBER 14, 2022

In this article she looks at specific ways to engage and communicate with Nursing, Physicians, Sales & Marketing, Revenue Cycle, and IT. Here, any overpayment from a governmental payer source must be returned within 60 days of its identification. Build relationships with key clinical and operational areas.

Compliance 52

Compliance Compliance Officers Nurses Overpayments 52

Healthcare Law Blog

FEBRUARY 9, 2024

Sherman himself had submitted disclosure logs to the OIG), Sherman alleges that it failed to adequately report the arrangements it had with Neonatology Associates or any other private physician groups, or return any alleged overpayments. The article refers to all entities as ChristianaCare consistent with Defendants’ briefing. [2]

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Compliancy Group

FEBRUARY 7, 2024

This article explores the purpose of UPIC audits and who should be concerned – providing a comprehensive guide on how healthcare organizations can prepare for these audits. The outcome of these audits can range from repayment of overpayments to criminal prosecution in cases of fraud. What is the Purpose of UPIC Audits?

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Moreover, compliance professionals should report activities such as upcoding or unbundling in a timely manner so overpayments can be promptly returned. Everything is validated by a third-party law firm.   Get the latest from healthcare compliance experts  Never miss an article by Denise Atwood.

US Department of Health and Human Services 52

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

AIHC

OCTOBER 23, 2024

The information provided in this article is not comprehensive and not intended as consulting or legal advice. Corrective action includes refunding overpayments revealed during the audit. Federal law requires entities repay any overpayments received from Medicare or a State Medicaid program within 60 days after identification.

Compliance 52

Compliance Overpayments Overpayment Medicaid 52

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.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

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

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?

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Hall Render

DECEMBER 6, 2022

Please visit our previous article for a more detailed discussion of the waivers and what constitutes a “COVID-19 Purpose.” Hall Render blog posts and articles are intended for informational purposes only. The Stark waivers are only applicable to financial arrangements related to a proper “COVID-19 Purpose.”

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

Hall Render

DECEMBER 11, 2024

Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannotoutside of an attorney-client relationshipanswer specific questions that would be legal advice.

Compliance 40

Compliance Licensing Nurses Medicaid 40

Hall Render

NOVEMBER 25, 2024

The Nursing Facility ICPG provides that, even if an entity makes an isolated billing error, the entity still has an obligation to repay the overpayment to the government to avoid False Claims Act liability, as explained in the GCPG. Hall Render blog posts and articles are intended for informational purposes only.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

Physician Credentialing Company

DECEMBER 4, 2024

In this article, well outline the main differences between these two codes, when each should be used and billing tips to ensure accurate payment. Another myriad of offices may code outpatient visits with CPT code 99204 and CPT code 99205, two of the most utilized CPT codes for new patient office or other outpatient visits.

Medical Billing 40

Medical Billing Overpayments Overpayment Electronic Medical Records 40