MRO Compliance

JANUARY 16, 2025

To address these gaps, the Centers for Medicare & Medicaid Services (CMS) now mandates the use of FHIR-based APIs for data sharing. Many claims analysts feel that chasing down overpayments feels like plugging leaks in a sinking boat. This is why payers are now shifting toward pre-pay accuracy.

Overpayments 130

Overpayments Overpayment Regulatory Compliance Patient Satisfaction 130

Health Care Law Brief

JUNE 26, 2022

With this denial, the Overpayment Rule remains in full force and effect, and UnitedHealthcare, among other MA plans, must comply or potentially face False Claims Act (FCA) liability. The Overpayment Rule. The Overpayment Rule, set forth at 42 U.S.C. 29844, 29921 (May 23, 2014). See UnitedHealthcare Insurance Co. 3d 173 (Sep.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

HIT Consultant

SEPTEMBER 27, 2024

Risk adjustment requires constant attention to ensure accurate coding, timely regulatory compliance, and streamlined communications across the payer-provider continuum. billion in overpayments to MA plans with this new audit methodology over the next ten years. In one recent audit, OIG found at least $3.7

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Florida Health Care Law Firm

DECEMBER 2, 2021

The OIG clarified that using the SDP may mitigate potential exposure under Medicare and Medicaid 60-day reporting and returning requirements for overpayments. Any overpayment retained after this period may create liability under the Civil Monetary Penalties Law and the False Claims Act.

Overpayments 40

Overpayments Overpayment Fraud Medicare 40

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. Competency-Based Training.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40