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Monitor Improper Payments for Part C and Part D with Medicare Audit and Monitoring Software

Innovaare Compliance

The monthly premium for Medicare Part B rose 14.5%, from $148.50 By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1] By law, the Medicare Part B monthly premium must equal 25% of the estimated total Part B costs for enrollees age 65 and over. [1]

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Preventing Genetic Testing Fraud: 5 Actions for Health Plans

Healthcare IT Today

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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Introduction to Telebehavioral Health

AIHC

Higher rates of use of telehealth are now standard in many practices since the coronavirus disease 2019 (COVID-19) pandemic. Medicare covers many telebehavioral and telemental health services including audio-only services. Store-and-forward is less commonly reimbursed by Medicare and Medicaid programs.

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A million-dollar healthcare compliance monitoring mistake 

YouCompli

The net of it is this: Our Compliance Department performed a compliance audit related to sleep studies that resulted in a significant payback to the federal government that could have been avoided if monitoring was being performed by the Sleep Center Clinical leadership. That’s a 41% error rate with an extrapolated overpayment of?$269

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Part 2: Understanding How Payers Deny Claims

AIHC

The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?

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Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

Kaiser Health News

Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel Tuesday. Those trade-offs aside, Medicare Advantage is clearly proving attractive to consumers.

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