The Final Rule: How to Prevent $389,000 in Medicare Overpayments
Healthicity
FEBRUARY 8, 2022
New York Hospital to Pay $389,000 to Medicare. In a recent audit of a New York hospital, the HHS OIG identified overpayments.
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Healthicity
FEBRUARY 8, 2022
New York Hospital to Pay $389,000 to Medicare. In a recent audit of a New York hospital, the HHS OIG identified overpayments.
Healthcare Law Today
JANUARY 2, 2023
As written, the proposed rule would remove the existing “reasonable diligence” standard for identification of overpayments, and add the “knowing” and “knowingly” FCA definition. And, a provider is required to refund overpayments it is obliged to refund within 60 days of such identified overpayment.
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Healthicity
NOVEMBER 29, 2022
Health and Human Services Office of Inspector General (OIG) recently issued a report concluding that Medicare and patients combined overpaid more than a million dollars for the same professional services provided at critical access hospitals (CAH). Who Bills for Professional Services?
NEJM
JANUARY 13, 2023
A 2022 Supreme Court ruling raises questions about the 340B program’s outsized effect on the health care system’s structure and on the role of hospitals in providing care to underserved populations.
Health Care Law Brief
APRIL 12, 2023
On April 5, the Centers for Medicare & Medicaid Services (“CMS”) released the 2024 Medicare Advantage and Prescription Drug Benefit Programs Final Rule (“Final Rule”), which will be codified at 42 C.F.R. The SRFs include low-income subsidy, dual eligibility (meaning eligible for Medicare and Medicaid) and disability.
Healthcare IT Today
FEBRUARY 22, 2023
There’s widespread consensus that payments to Medicare Advantage Organizations (MAOs) are a mess. These programs, which care for more than 30 million of the nearly 64 million Medicare enrollees , operate on the cutting edge of health care and suffer serious problems in data collection and billing.
Healthcare Compliance Blog
APRIL 14, 2022
The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.
Healthcare IT Today
FEBRUARY 25, 2023
Read more… Retrieving Billions in Medicare Overpayments. Improper payments for Medicare are estimated to exceed $43 billion per year, and determining overpayments in open-ended value-based Medicare Advantage plans poses a problem. Read more… Fixing Medicare Advantage Payments.
The Health Law Firm Blog
NOVEMBER 18, 2023
Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.]
The Health Law Firm Blog
AUGUST 23, 2022
Supreme Court said the federal government improperly cut more than $1 billion a year in Medicare reimbursements to hospitals. Indest III, J.D., Board Certified by The Florida Bar in Health Law On June 15, 2022, the U.S. This came in a ruling that limits regulators’ power to control what the program pays for certain [.].
Healthcare IT Today
NOVEMBER 22, 2022
The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. Tricare and Medicare).
YouCompli
FEBRUARY 22, 2023
Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. It is “prospective” because hospitals and other providers know ahead of time what they will be reimbursed. The CCR is determined by a hospital’s cost report that is reconciled with the local Medicare contractor.
McBrayer Law Blog
NOVEMBER 18, 2020
Posted In Code Enforcement , Hospitals It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake.
Healthcare IT Today
JANUARY 17, 2024
Insights are also from auditing professional and hospital claims totaling more than $5 billion and denials from commercial and government payors exceeding $150 billion. Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S.
Healthcare IT News - Telehealth
JUNE 8, 2022
But even now, hospitals and health systems should be preparing proactively to meet the regulatory demands of a post-PHE future. Additionally, several telehealth flexibilities (that generally expand Medicare coverage for telehealth services) have been extended 151 days (about five months) beyond the termination of the HHS PHE.
The Health Law Firm
OCTOBER 9, 2013
Board Certified by The Florida Bar in Health Law The University of Miami Hospital allegedly owes Medicare $3.7 This is according to an audit report of the hospital’s billing practices that found the hospital allegedly overbilled the health care program in 2009 and 2010. Indest III, J.D.,
The Health Law Firm
JULY 26, 2012
On July 2, 2012 the Officer of Inspector General (OIG) released its Medicare compliance review of West Florida Hospital in Pensacola. According to the audit, the hospital complied with Medicare billing requirements for the documentation majority of inpatient and outpatient claims. Official Break Down of the Audit.
Compliancy Group
FEBRUARY 29, 2024
When a hospital, doctor’s office, or other healthcare organization is guilty of a regulatory or compliance violation , the U.S. Office of Inspector General (OIG) can invoke civil or criminal prosecution or licensure or other penalties, fines, exclusions from federal programs like Medicare, or revocation of billing privileges.
Healthcare IT Today
FEBRUARY 17, 2023
Amid swirling accusations that Medicare Advantage Organizations (MAOs) are overbilling the U.S. government and calls for better oversight , the Centers for Medicare & Medicaid Services announced in early February that it would investigate overbilling by those plans. How can such overpayments be uncovered?
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. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.
Hall Render
DECEMBER 27, 2023
Under the federal Stark Law, hospitals, physician groups, labs and other provider entities may provide non-monetary ( i.e. , non-cash or cash equivalent) compensation to physicians up to an aggregate amount of $507 for calendar year 2024. and the entity may not bill for such services unless an exception is met.
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.
Hall Render
APRIL 19, 2024
to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M
Hall Render
MAY 10, 2024
Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’
Innovaare Compliance
JUNE 28, 2022
The Centers for Medicare & Medicaid Services (CMS) launched a new cycle of CMS program audits in February 2022. This causes claims to providers to be paid incorrectly, which results in enrollees being overcharged for their coinsurance or delayed refund of overpayments. .
Hall Render
DECEMBER 6, 2022
Under the federal Stark Law, hospitals, physician groups, labs and other provider entities may provide non-monetary (i.e., The dollar limit for “medical staff incidental benefits” provided by a hospital to a member of its medical staff (e.g., and the entity may not bill for such services, unless an exception is met.
Hall Render
FEBRUARY 23, 2024
NATIONAL 382 rural hospitals cut chemotherapy, breakdown by state 1 year after Amazon-One Medical deal finalized: What’s happened since ACOs want increased participation of long-term and post-acute care providers ‘Behind the times’: DC tries to catch up with AI’s use in health care CMS finalizes DSH payment cuts for some safety-net hospitals: (..)
AIHC
SEPTEMBER 5, 2023
Medicare covers many telebehavioral and telemental health services including audio-only services. Most private insurers and Medicaid cover telebehavioral health care, but check for reimbursement restrictions and obtain professional coding and billing guidance to avoid overpayment situations.
AIHC
APRIL 5, 2022
If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. A great free modifier resource to share with you is the CMS Medicare Administrative Contractor (MAC) “WPS” learning center with on-demand training materials.
Hall Render
JUNE 30, 2023
for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M Here’s why.
YouCompli
SEPTEMBER 27, 2023
Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. Since claims are submitted electronically, Medicare and others use a system of claims edits to avoid paying claims inappropriately.
AIHC
MARCH 28, 2022
The complex Medicare appeals process is used to demonstrate the importance of appealing claims denied in an audit. The learning objective of this lesson is to help you become familiar with the Medicare Claims Review Program (MCRP). Other payers mirror Medicare’s program. Audited by a payer? What is an “improper” payment?
Hall Render
APRIL 18, 2022
CMS plans to increase Medicare reimbursement for SNFs by 3.9% reduction in funds to account for overpayments by CMS in previous years per Modern Healthcare. Banner Health is in the process of buying 40 to 50 acres in Scottsdale, AZ for a new hospital per Phoenix Business Journal. in fiscal year 2023.
Health Law RX
NOVEMBER 9, 2021
CMS has agreed to suspend statutory obligations to report or return overpayments while the OIG negotiates a settlement with providers who are following the SDP. The likelihood that a self-discloser would be required to pay a damages multiplier greater than 1.5
Hall Render
APRIL 26, 2024
NATIONAL 5 numbers on the rise of Stark law violations 3 takeaways on the new federal data privacy proposal after its first public showcase 80% of Change Healthcare restored after cyberattack Authentication failure blamed for Change Healthcare ransomware attack Biden administration issues new rule to protect privacy of those seeking reproductive health (..)
Hall Render
OCTOBER 7, 2022
After court ruling for AHA in 340B case, HHS says it will start adjusting payment rates for certain 340B hospitals within approximately two weeks. Congress gives rural hospitals a reprieve, for now. Hospital leaders meet at White House to talk ‘twindemic’ strategies. Is the doctor’s office heading for extinction?
Hall Render
NOVEMBER 10, 2023
NATIONAL 340B repayments welcomed but concern remains, hospital group says 4 pieces of legislation fighting to alleviate the physician shortage crisis AHA Files Lawsuit Challenging HHS Guidance on Tracking Technologies AHA says 3.1% Where are Leapfrog’s 11 ‘F’ hospitals?
Hall Render
MARCH 22, 2024
NATIONAL 79 percent have positive outlook for senior living and care: NIC 12 key legal issues impacting health systems AHA: 94% of hospitals financially impacted by Change Healthcare’s cyberattack A conversation about the HHS plan on AI in health care A new kind of hospital is coming to rural America.
Hall Render
MARCH 15, 2024
NATIONAL 3 things to expect from the pharmaceutical supply chain in 2024 Absence of AI hospital rules worries nurses American Academy of Dermatology votes to keep its diversity policies after anti-DEI proposal Are digital health partnerships replacing M&A? From -6.8%
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