In Audit
Apr 4th, 2022
Round 1 of Novitas Solutions’ targeted probe and educate (TPE) review for outpatient physical and occupational therapy (CPT® codes 97010-97546) indicates there is room for improvement in getting claims paid. TPE Results Are In The Medicare Administrative Contractor’s (MAC) TPE round 1 results for CPT® 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic ...
Perform well when faced with a RADV audit. If you’re a hierarchical condition category (HCC) coder, no doubt you’ve heard of risk adjustment data validation (RADV) audits. There are various types of RADV audits that are performed by the Centers for Medicare & Medicaid Services (CMS) including contract-level RADV audits and improper payment measure audits ...
In Audit
Mar 31st, 2022
Case is just one of many in an alleged $8 billion pandemic fraud spree, according to DOJ. The feds are keeping an ever-sharper eye out for fraud related to COVID-19 relief funds, and a California hospice owner was one of the fraudsters spotted. Gurgen Israyelyan owned Saint Christopher Hospice Inc. in North Hollywood, which closed ...
In Audit
Mar 1st, 2022
Know what to look for when auditing behavioral health services to keep your organization compliant. One of the best things you can do prior to auditing outpatient and inpatient behavioral health claims is to review federal and state regulations. But understanding the coding and documentation requirements for inpatient and outpatient behavioral health services can make ...