Remove category provider
article thumbnail

Healthcare Compliance Risks with Urine Drug Testing Overpayments 

YouCompli

There has been significant enforcement over the last couple years relating to overpayments for UDT. In general, there are two major categories of UDT. The overpayment rate for definitive drug testing for 22 or more drug classes was over 71%. What do all these entities and settlements have in common? What is Urine drug testing?

article thumbnail

CMS Publishes RADV Audit Methodology and Intent to Recover Overpayments

Hall Render

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. Background RADV audits are the main tool that CMS uses to correct overpayments made to MAOs.

Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

OIG Posts False Claims Act Settlements for FY 2022 Q1–Q4 on the Risk Spectrum

Med-Net Compliance

The OIG applies published criteria to assess future risk and places each party to an FCA settlement into one of five categories on a risk spectrum. The OIG uses its exclusion authority differently for parties in each category and bases its assessment on the information it has reviewed in the context of the resolved FCA case.

Fraud 59
article thumbnail

Compliance is Everybody’s Business: Clinical, Revenue Cycle, IT, Sales and Marketing

YouCompli

Sharon Parsley, JD, MBA, CHC, CHRC contributes a monthly post on compliance officer effectiveness for the YouCompli blog. Many people in our discipline love the slogan “compliance is everybody’s business.” In the process, they became compliance champions. Seize every opportunity to demonstrate that compliance is not the police.

article thumbnail

Part 3: Audit Documentation to Avoid Potential Appeal Consequences

AIHC

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. Due to the huge volume of claims payers receive to process, deny and pay, they have implemented various methods to track providers to detect potential waste, fraud and/or abuse. Detect a Problem?

Fraud 52
article thumbnail

The Power of a Quality Review: Your Best Defense Against OIG Audits

Healthcare IT Today

In turn, this should also build more meaningful connections between providers and members as they work together to document and promote patient health. Target audits highlight areas for provider education. You can audit by condition, individual provider, demographic, provider group, or facility.

article thumbnail

Part 2: Understanding How Payers Deny Claims

AIHC

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. The Medicare Fee-for-Service Compliance programs prevent, reduce, and measure improper payments in FFS Medicare through medical review.