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Compliance Risks Associated with Outlier Payments 

YouCompli

Price increases can sometimes result in inappropriate outlier payments. 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).

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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. ” The health plan required patients to have an X-ray first to prove a CT scan was needed.

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