YouCompli

FEBRUARY 22, 2023

Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). The inflated charges resulted in inappropriate outlier payments from Medicare.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

Natalia Mazina

JULY 3, 2022

Only in 2020, it started sending notices of recoupment to pharmacies specifying the amounts owed. This lead to overpayments to pharmacies. For technical and financial reasons, the DHCS has not implemented the new reimbursement methodology until 2019.

Overpayments 52

Overpayments Overpayment Patient Advocacy Medicaid 52

Healthcare Compliance Blog

JUNE 9, 2022

Between 2017 and 2019, the man, through a group of pain clinics he controlled, caused the submission of false claims for payment to Medicare. HHS-OIG will continue to work with the US Attorney’s Office to ensure the integrity of the Medicare Trust Fund.”. He is awaiting sentencing on those charges.

US Department of Health and Human Services 59

US Department of Health and Human Services Medicare Medicare Overpayments 59

Innovaare Compliance

MARCH 24, 2024

The Centers for Medicare & Medicaid Services (CMS) reported that in the fiscal year 2020, they recovered $3.1 Retrieved from [link] Centers for Medicare & Medicaid Services. 2020 AMA Prior Authorization (PA) Physician Survey. Retrieved from [link] Centers for Medicare & Medicaid Services. 2021, April).

Fraud 52

Fraud Health Insurance Compliance Medicaid 52

AIHC

MARCH 28, 2022

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?

Medicare 52

Medicare Medicare Compliance Governance 52

HIT Consultant

MARCH 1, 2022

In Ohio, unemployment overpayments reached $3.86 billion on their MES and eligibility and enrollment systems, according to a 2020 report by the Government Accountability Office (GAO). Centers for Medicare and Medicaid Services (CMS) reimbursed states $34.3 billion during the pandemic. billion of that amount.

Medicaid 52

Medicaid Medicaid Overpayments Overpayment 52

Hall Render

APRIL 18, 2022

The Public Health Emergency has been in effect since January 27, 2020. CMS plans to increase Medicare reimbursement for SNFs by 3.9% reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare. in fiscal year 2023. The increase will be reduced by a 4.6%

Public Health 40

Public Health COVID-19 Overpayments Overpayment 40

Hall Render

JUNE 22, 2022

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). The industry has been waiting for CMS to assess behavior again since 2020. is a decline from 2020, in which 8.9%

COVID-19 40

COVID-19 Payment Systems Medicare Medicare 40

AIHC

SEPTEMBER 5, 2023

Medicare covers many telebehavioral and telemental health services including audio-only services. Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations.

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Hall Render

DECEMBER 6, 2022

As part of the final regulations released by the Centers for Medicare & Medicaid Services (“CMS”) effective January 19, 2021, CMS finalized a new exception for arrangements where an entity pays a physician less than $5,000 over the course of a calendar year in exchange for items or services. New Exception for Limited Remuneration.

COVID-19 40

COVID-19 Hospitals Overpayments Overpayment 40

Hall Render

APRIL 19, 2024

George’s hospital nears groundbreaking on new tower after landing millions from state Maryland program for specialist physicians reports initial Medicare savings Why private equity is investing in Maryland’s emergency departments Why the long wait? Can lawmakers do anything about it?

Nursing Homes 40

Nursing Homes Nurses Hospitals Doctors 40

Hall Render

JANUARY 19, 2024

Workers at another D.C. Here’s how much more they’ll be paying St.

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40