Remove Governance Remove Overpayments Remove Payment Systems
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Breaking Down the OIG’s First Industry-Specific Guidance 

YouCompli

Quality of Care and Quality of Life For decades, the OIG and other government enforcement agencies have emphasized the importance of the quality of care and quality of life for nursing facility residents. This first ICPG covers Skilled Nursing Facilities and Nursing Facilities. Lets review some of the highlights.

Nurses 52
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Compliance Risks Associated with Outlier Payments 

YouCompli

This is why Medicare publishes its rules on their Inpatient Prospective Payment System (IPPS) or its Outpatient Prospective Payment System (OPPS). However, there are certain circumstances when Medicare, for example, will reimburse additional amounts beyond the prospective payment rate.

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OIG Issues Highly Anticipated Industry Segment-Specific Compliance Program Guidance for Nursing Facilities

Hall Render

The Nursing Facility ICPG provides that, even if an entity makes an isolated billing error, the entity still has an obligation to repay the overpayment to the government to avoid False Claims Act liability, as explained in the GCPG.

Nurses 40
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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.

Medicare 107