Remove Document Remove Medical Billing Remove Overpayments
article thumbnail

Understanding Basics of Medicare Overpayment

Medisys Compliance

What is Medicare Overpayment? An overpayment is a payment made to a provider exceeding amounts due and payable according to existing laws and regulations. Identified overpayments are debts owed to the federal government. Laws and regulations require CMS recover overpayments. Medicare Overpayment Collection Process.

article thumbnail

Fixing Medicare Advantage Payments

Healthcare IT Today

CMS requires chart reviews to catch overpayments. Reasons for chart reviews include: Finding clinical interventions that weren’t correctly billed, or perhaps weren’t billed at all. Medicare Advantage programs thus have incentives to uncover and bill for every condition that introduces risk.

Medicare 118
Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

SNF Billing Compliance Made Simple

Medisys Compliance

SNF Billing Compliance Guidelines Adhering to SNF billing guidelines involves understanding complex policies and keeping up-to-date with evolving regulations. Here are some essential aspects: Documentation Requirements: Detailed medical records supporting the necessity of skilled care.

article thumbnail

Preparing for Payer Coding Audits

Medisys Compliance

You want unique documentation for each encounter, and it should stand out in your progress note. In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first. We ensure that you use accurate procedure codes and modifiers and maintain proper documentation.

article thumbnail

Enhancing Payment Integrity in Healthcare through Pre-Payment Reviews

Healthcare IT Today

It’s estimated that up to 80 percent of medical bills contain errors amounting to billions of dollars that are lost annually to payers. This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected. Providers navigate abrasive recoveries and revenue instability.

article thumbnail

Navigating CMS UPIC Audits: A Guide for Healthcare Organizations

Compliancy Group

Through a combination of data analysis, investigations, medical reviews, and site visits, UPICs scrutinize healthcare providers and suppliers to ensure compliance with billing rules and the provision of medically necessary services. Healthcare organizations can take several steps to prepare for a UPIC Medicare audit.

Fraud 52
article thumbnail

CPT Code 99204 vs 99205 – Comparison and Guide

Physician Credentialing Company

The differences in CPT (Current Procedural Terminology) codes is one of the most important aspects of medical billing and coding for healthcare providers. These errors commonly occur from misinterpretation of the CPT coding guidelines, lack of documentation, or incorrect use of the coding rules.