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.,

Medicare 105

Medicare Medicare Overpayments Overpayment 105

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.

Payment Systems 78

Payment Systems Overpayments Overpayment Medical Billing 78

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.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

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.

Nurses 40

Nurses Compliance Compliance Officers Medicare 40

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.

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

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.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

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

Medicare 107

Medicare Medicare Governance Overpayments 107