Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. billion in overpayments from MAOs for payment years 2011 through 2017. Further, CMS estimates that beginning with payment year 2018, it will identify approximately $479 million per audit year in overpayments to MAOs.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. Return illegitimate reimbursement and overpayments quickly. The government has a 60-day overpayment rule.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. For healthcare organizations, understanding UPIC audits and preparing for them is essential to compliance. What is the Purpose of UPIC Audits?

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

US Department of Health and Human Services Compliance Officers Compliance Fraud 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. This article is not intended as legal or consulting advice. This is also called “store-and-forward telemedicine.”

COVID-19 59

COVID-19 Telemedicine Compliance Informed Consent 59

Healthcare IT Today

FEBRUARY 2, 2023

The following is a guest article by Rebecca Darnall, R isk Adjustment Leader at Episource. These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS).

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. Diagnosis codes are an important compliance aspect of reporting medical necessity on the claim.

Fraud 52

Fraud Compliance Medicare Medicare 52