In Audit
Jan 3rd, 2020
Coding initial hospital care became more challenging after Medicare stopped paying for inpatient consult codes several years ago — but that can’t be the only factor driving the startling error rates for evaluation and management (E/M) codes 99223 and 99214. In the report “2019 Medicare Fee-for-Service Supplemental Improper Payment Data,” the Centers for Medicare & ...
In Audit
Dec 17th, 2019
The Office of Inspector General (OIG) expects a banner year in recoveries stemming from fraud investigations and audits. According to the OIG semiannual report, released Dec. 2, the U.S. Department of Health and Human services (HHS) stands to recoup as much as $5.9 billion in federal funds in 2019, The semiannual report estimates the OIG will ...
In Audit
Nov 27th, 2019
Consistent with previous reporting, the Office of Inspector General (OIG) has added to its 2020 Work Plan a targeted audit of Medicare Advantage (MA) programs for risk adjustment diagnosis codes. This is not the first time federal agency has targeted risk adjustment data. The OIG stated back in 2017, “We will review the medical record ...
In Audit
Nov 14th, 2019
Chronic care management (CCM) services are services that do not involve face-to-face patient/provider contact. The Centers for Medicare & Medicaid Services (CMS) implemented Medicare coverage for CCM in Jan. 1, 2015. There are very specific guidelines providers need to follow to be reimbursed for CCM services rendered to Medicare patients, but it appears CMS is ...
In Audit
Nov 6th, 2019
Many healthcare organizations are seeking to reduce expensive physical office space, improve employee morale, and offer flexible options for the workforce; telecommuting has emerged as a commonplace solution for many of us. How can a compliance officer embrace these more prevalent and relevant offsite employee worksite opportunities while still demonstrating they are managing risks to ...