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
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 ...
Sep 11th, 2018
Scrubbing is the best way to ensure your claims are clean of unbundling overpayments. A hospital finance department should not treat National Correct Coding Initiative (NCCI) edits as irrelevant to inpatient billing simply because payers don’t use the NCCI to edit inpatient claims before payment. Instead, hospitals should institute internal controls to ensure claims are ...
In CMS
Apr 13th, 2018
An Office of Inspector General (OIG) report found the Centers for Medicare & Medicaid Services (CMS) reimbursed some telehealth claims that didn’t meet Medicare requirements, according to a release from the oversight group. OIG Found Incomplete Claims The OIG analyzed 191,118 2014 and 2015 telehealth claims and discovered that more than half of the professional telehealth services report...
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 ...