In Audit
Feb 20th, 2018
A specimen validity test performed on the same day as a urine drug test for the same person should be a rare occurrence because specimen validity testing is included in the description of HCPCS Level II codes for urine drug tests. Billing both tests separately is like double-dipping. And yet, Medicare paid 4,180 clinical laboratories and physician offices ...
In Audit
Jan 26th, 2018
The Centers for Medicare & Medicaid Services (CMS) measures the fee-for-service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. According to a 2017 CERT report, CMS had a 90.5 percent proper payment rate and a 9.5 percent improper payment rate for all claims submitted July 1, 2015, to June 30, 2016. ...
Jan 4th, 2016
No. 1 on the top 20 list of types of services with downcoding errors is (drum roll, please)… established office visits, according to the U.S. Department of Health & Human Services (HHS) Supplementary Appendices for Medicare Fee-for-Service (FFS) 2015 Improper Payment Report. Under the direction of the Centers for Medicare & Medicaid Services (CMS), the ...
In Audit
Nov 18th, 2015
This week, the U.S. Department of Health & Human Services (HHS) released its annual Agency Financial Report, which includes an update on the improper payment rates for Medicare, Medicaid and others. This year’s report shows progress is being made to reduce improper payments in the following areas: The Medicare fee-for-service improper payment rate decreased from ...
In Audit
Jul 30th, 2010
The Patient Protection and Affordable Care Act (health reform law) enacted earlier this year mandates the expansion of recovery audit contractor (RAC) audits beyond Medicare to Medicaid by the end of this year. While RACs are gung-ho to begin auditing, administrators at the Centers for Medicare & Medicaid Services (CMS) are voicing concerns whether coordinating with 50 ...