MRO Compliance

JANUARY 16, 2025

Many claims analysts feel that chasing down overpayments feels like plugging leaks in a sinking boat. By using real-time analytics and data validation tools, payers can catch errors before claims are paid, reducing overpayments, denials, and administrative friction. This is why payers are now shifting toward pre-pay accuracy.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

Medisys Compliance

JULY 5, 2022

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.

Overpayment 52

Overpayment Overpayments Medicare Medicare 52

Healthcare IT Today

FEBRUARY 22, 2023

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

Medicare Medicare Overpayments Overpayment 118

Medisys Compliance

MARCH 7, 2022

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.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Overpayments Overpayment 52

Medisys Compliance

NOVEMBER 26, 2024

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.

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 52

Healthcare IT Today

FEBRUARY 2, 2024

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.

Payment Systems 78

Payment Systems Overpayments Overpayment Medical Billing 78

Compliancy Group

FEBRUARY 7, 2024

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

Fraud Compliance Medicare Medicare 52