Overpayment Overpayments Payment Systems 
Healthcare Law Blog
FEBRUARY 1, 2023
Statutory and Regulatory Authority : CMS cited its statutory authority to audit providers and recoup improper payments under the Medicare statute. Likewise CMS cited its fiduciary duty to protect taxpayer dollars from overpayments and its fiduciary responsibility to recover funds due to the Medicare Trust Funds. Becerra et al.,
YouCompli
FEBRUARY 22, 2023
This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). However, there are certain circumstances when Medicare, for example, will reimburse additional amounts beyond the prospective payment rate.
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Healthcare IT Today
FEBRUARY 2, 2024
Payers battle administrative overload caused by reconciling inaccurate payments and reprocessing claims to pay the accurate reimbursement amount. This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected. In adopting pre-payment systems, the synergy between payers and providers is paramount.
Hall Render
NOVEMBER 25, 2024
The Nursing Facility ICPG provides that, even if an entity makes an isolated billing error, the entity still has an obligation to repay the overpayment to the government to avoid False Claims Act liability, as explained in the GCPG. It is intended only to assist nursing facilities in evaluating and mitigating their own particular risk areas.
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. That file may be accessed here.
Hall Render
MARCH 15, 2024
Million Hospital Will Bridge Western Wyoming Health Care Gap Gillette representative’s healthcare legislation signed into law The post Health Provider News appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.
Kaiser Health News
JUNE 29, 2022
They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions in suspected overpayments to the health plans, which are run mostly by private insurance companies. Bliss said Medicare paid $2.6
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