Medicare Compliance & Reimbursement

Providers pass on OIG's second chance to submit medical records. You have most likely heard the phrase "if it wasn't documented, it wasn't done" so many times that it's old hat. And yet, insufficient and missing documentation remains one of the biggest denial reasons among Medicare contractors. The HHS Office of Inspector General tried to improve upon that denial rate by offering providers a second chance to turn in required documentation, a new OIG report says. But the majority passed on the offer, leaving contractors no choice but to request a refund of the money that providers had received for those services. Background: When CERT (Comprehensive Error Rate Testing) reviewers find that Medicare paid for claims that are missing documentation, CERT reviewers contact providers up to three times to request complete documentation to support the claims. In cases when the documentation is not sufficient, the providers have to return the [...]