Medicaid Overpayment Payment Systems 
YouCompli
FEBRUARY 4, 2025
When a nursing facility submits a claim to Medicare or Medicaid for reimbursement, it certifies the services were provided in compliance with all applicable statutes, regulations, and rules. Even if an entity makes an isolated billing error, that entity still has an obligation to repay the overpayment to avoid False Claims Act liability.
Compliancy Group
FEBRUARY 12, 2025
Using the ICPG to Maintain an Effective Compliance Program The Centers for Medicare & Medicaid Services (CMS) has issued participation requirements for nursing facilities in the Medicare and Medicaid programs (Requirements of Participation or ROPs). The ICP covers the areas listed below.
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Healthcare Law Blog
FEBRUARY 1, 2023
On January 30, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the long-delayed final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”). case number 18-5326 , which reinstated CMS’s Overpayment Rule for MA organizations. See also Ratanasen v.
YouCompli
FEBRUARY 22, 2023
Price increases can sometimes result in inappropriate outlier payments. 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).
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
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.
Kaiser Health News
JUNE 29, 2022
The watchdogs also recommended imposing limits on home-based “health assessments,” arguing these visits can artificially inflate payments to plans without offering patients appropriate care. ” The health plan required patients to have an X-ray first to prove a CT scan was needed. Bliss said Medicare paid $2.6
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