In Audit
Nov 22nd, 2017
The Office of Inspector General (OIG) is recommending Rush University Medical Center, Chicago, Ill., refund $10.2 million in Medicare overpayments based on an audit sample of 120 inpatient and outpatient claims. Rush allegedly did not fully comply with Medicare billing requirements for 57 of the claims, resulting in overpayments of $814,150 for the audit period (2014-2015). The OIG ...
In Audit
Jan 19th, 2017
In the 2017 Work Plan, the Office of Inspector General (OIG) is reviewing Medicare’s billing and reimbursement integrity for two diagnosis-related groups (DRGs): inpatient claims for kwashiorkor diagnosis and mechanical ventilation. Kwashiorkor is a severe protein malnutrition that usually “affects children living in tropical and subtropical parts of the world during periods of famine or ...
Dec 13th, 2016
Account for DRG and comorbidity adjustments and ensure all active medical treatments and diagnoses are documented. Part of our responsibility as healthcare business professionals is to understand the financial realities of healthcare delivery and reimbursement. For those of us working in mental health, this means learning the “ins and outs” of the Inpatient Psychiatric Facility ...
Jun 1st, 2013
OIG is targeting high rates for these services, so work together to be sure yours are necessary. By Barbara Aubry, RN, CPC, CHCQM, FAIHQ As a regulatory analyst for 3M Health Information System, I spend a portion of each day reviewing regulatory changes and updates, Office of Inspector General (OIG) actions, the Centers for Medicare ...
Apr 1st, 2013
By William C. Fiala, MA, CPC, CCS-P, and Nicholas J. Jouriles, MD, FACEP Research and reporting going back nearly two decades suggests that hospital inpatients are increasingly sicker, and their care more complicated. Intuitively, this greater inpatient acuity should result in higher emergency department (ED) evaluation and management (E/M) service levels for those patients admitted ...