Hall Render

FEBRUARY 14, 2023

billion in overpayments from MAOs for payment years 2011 through 2017. 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.

Overpayments 40

Overpayments Overpayment Medicare Medicare 40

Med-Net Compliance

OCTOBER 21, 2022

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

Fraud Compliance Medicare Medicare 59

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). Base rates are risk adjusted to account for certain factors related to a beneficiary (e.g., June 21, 2022) (No.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

FEBRUARY 2, 2023

These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS). Target audits highlight areas for provider education. did the provider education improve documentation?).

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

APRIL 5, 2022

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

Fraud Compliance Medicare Medicare 52

Healthcare Law Blog

SEPTEMBER 28, 2023

The Centers for Medicare & Medicaid Services (“CMS”) released the final rule on risk adjustment data validation (“RADV”) audits of Medicare Advantage (“MA”) organizations (the “Final Rule”) on January 30, 2023. CMS previously addressed this problem and provided for a solution in its February 2012 announcement of the FFS Adjuster.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. A number of programs are provided to educate and support Medicare providers in understanding and applying Medicare FFS policies while reducing provider burden.

Medicare 52

Medicare Medicare Compliance Governance 52