Medicaid Overpayments Payment Systems 
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).
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
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.
Hall Render
MARCH 15, 2024
of Labor projects 6000 health care job openings per year Negotiations between Local 17 Nurses and Providence St. Patrick Hospital to take place at later date St.
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
Expert insights. Personalized for you.
105 
Let's personalize your content