Recent Medicare Program Changes

Providers, suppliers and their billing staff need to be aware of the following recent changes to the Medicare program.

Continue reading »

CMS Implements Home Health Pre-Claim Review in 5 States

The Centers for Medicare & Medicaid Services (CMS) recently launched a demonstration project that will initiate a pre-claim review for home health services. The project seeks to lower a nearly 60 percent claims error rate stemming largely from insufficient documentation.

Continue reading »

Latest Medicare Changes That Will Impact Your Practice

The Centers for Medicare & Medicaid Services (CMS) has issued number of recent updates to the Medicare program which impact various providers and suppliers.

Continue reading »

Providers Beware: Medicare Proposes Harsh New Screening Requirements

The Centers for Medicare & Medicaid Services (CMS) has once again proposed new rules which would enhance the screening requirements for providers and suppliers. The rule proposals would ratchet up the scrutiny on provider enrollments and toughen suspension and revocation penalties.

Continue reading »

CMS Documentation Reminder to Physicians Ordering Lab Services

Recent results from the Comprehensive Error Rate Testing (CERT) Program revealed that the majority of improper payment for laboratory service result from insufficient documentation. This article summarizes important documentation recommendations from CMS.

Continue reading »

Chiropractic Billings Under Government Scrutiny Again

Consistently over the years the Office of Inspector General (OIG) has targeted chiropractic services for audits. In fact, chiropractic services appear annually on the OIG’s workplan agenda. In September 2015, the OIG issued a report recommending that the Centers for Medicare & Medicaid Services’ (CMS) establish better controls and measures to prevent questionable payments, collect overpayments based on inappropriately paid claims and ensure that claims are paid only for Medicare-covered diagnoses.

Continue reading »

OIG Finds OCR and Billing for Ambulance Services Needs Improvement

In a series of recent reports, the Office of Inspector General (OIG) noted a number of deficiencies and made a number of recommendations to improve and strengthen oversight of the HIPAA Privacy Standards and reduce the amount of inappropriate transportation billing.

Continue reading »

CMS and AMA Address Physicians’ ICD-10 Concerns

In a welcomed move, the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) announced elimination of certain sanctions and penalties during ICD-10 transition and the availability of additional resources to help physicians get ready for ICD-10.

Continue reading »

6 Medicare Reimbursement Issues on OIG’s Radar in 2015

In 2014, the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) reported “expected recoveries of over $4.9 billion.” The agency also excluded 4,017 individuals and entities and took 971 criminal actions. Similarly, the OIG pursued 533 civil actions against individuals and entities. According to the agency’s 2015 work

Continue reading »

GAO Report: CMS Needs to Improve Payment Contractors Oversight

A July Government Accountability Office (GAO) report identified deficiencies in the Centers for Medicare & Medicaid’s Services (CMS) oversight of Medicare audit contractors. The GAO Report further bolstered the long standing provider concerns about the auditing process.

Continue reading »

More Inspections and Scrutiny Under OIG’s 2013 Workplan

Each year the U.S. Department of Health and Human Services Office of the Inspector General (OIG) produces a work plan that outlines the agency’s focus for the upcoming year. With a staff of over 1,700 professionals, the OIG conducts investigations, audits, and, among other projects, enters and monitors corporate integrity agreements. Below we discuss some of the highlights from the OIG 2013 Work Plan.

Continue reading »

OIG Recoveries and Exclusions Rise in 2011

Recently, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) calculated the savings its programs brought to the Federal government in 2011. The statistics, which reveal recoveries in the billions, serve as a sobering reminder to providers of the increasing interest by the government in ensuring that providers are complying with the healthcare laws and regulations.

Continue reading »

Basis for Medicare Exclusion

The Office of the Inspector General (OIG) within the Department of Health and Human Services (HHS) has broad authority to take measures such as excluding providers and suppliers from participating in the Medicare Program in order to protect the program and beneficiaries. There are a number of reasons why exclusions may be imposed and we summarize them below.

Continue reading »

Prompt Action On Medicare Appeals Avoids Recoupment

Providers should know that if they plan to appeal a Recovery Audit Contractor’s (RAC) determination of overpayment they can avoid recoupment at the first and second levels of appeal if they act super timely.

Continue reading »

Private and Government Health Plans Form New Anti-Fraud Alliance

On July 26, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced an unprecedented partnership between private and public healthcare insurance organizations focused on fighting healthcare fraud.

Continue reading »

Wading Through The Medicare Alphabet Soup

The Medicare and Medicaid programs provide health insurance for tens of millions of people. According to Centers for Medicare and Medicaid Services (CMS), the Medicare program alone has 47.5 million beneficiaries and, in 2010, had total expenditures of $523 billion. It is not surprising, therefore, that such large programs invite scrutiny from government auditors and

Continue reading »

Consider Medicare Audit Appeal

There is a compelling reason for doctors to appeal Medicare audit for overpayments.

Continue reading »