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 ...
Shield your providers from lost revenue and noncompliance through internal auditing. If you treat billing, coding, and compliance audits like routine annual physicals or yearly flu shots, you’re shortchanging your practice or facility. While regular checkups are important to your health and that of your business, audits go beyond general maintenance. They could uncover coding ...
In Audit
Sep 2nd, 2019
Ensure your organization receives credit for its chronically ill patients where credit is due. Requests for medical records come from many sources for different reasons. One reason is for quality assessment review of clinical documentation by contractors paid by the Centers for Medicare & Medicaid Services (CMS) for hierarchical condition category (HCC) and Healthcare Effectiveness ...
In Audit
Aug 27th, 2019
The Centers for Medicare & Medicaid Services (CMS) knows that a significant amount of money is being overpaid to insurance companies in the Medicare Advantage program, but they have yet to recover these overpayments. That’s about to change. CMS says it will increase the audits being performed on Medicare Advantage risk-adjusted code submissions and apply ...