Compliance Officers Governance Medicare Overpayment 
YouCompli
MARCH 22, 2023
There has been significant enforcement over the last couple years relating to overpayments for UDT. Department of Health and Human Services Office of Inspector General (OIG) has expressed concerns about UDT billing. According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare.
YouCompli
SEPTEMBER 13, 2023
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. In addition, CMS education and outreach focuses on preventing, detecting, and reporting Medicare fraud and abuse.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
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.
YouCompli
OCTOBER 26, 2022
Let’s now look at a real scenario that I encountered as a Compliance Officer that supports having Clinical leadership perform monitoring, document the monitoring, and report out the results. In June 2019, the Office of the Inspector General (OIG) released findings and recommendations from a review of polysomnography [sleep] studies.
AIHC
APRIL 5, 2022
Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. If in doubt, check it out.
Expert insights. Personalized for you.
52 
Let's personalize your content