article thumbnail

CMS expands audits to crack down on Medicare Advantage overpayments

Healthcare Dive

The agency said it would increase the number of MA plan audits and complete its backlog of reviews by investing in technology and growing its medical coding workforce.

article thumbnail

Medicare Advantage overpayments could exceed $75B this year, study finds

Healthcare Dive

The figure is almost triple prior estimates of MA overpayments, highlighting the need for payment reform to avoid overtaxing the Medicare system, researchers said.

Insiders

Sign Up for our Newsletter

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

article thumbnail

SCOTUS rejects UnitedHealth appeal of Medicare Advantage overpayment rule

Healthcare Dive

The justices declined to take up the case, leaving intact a lower court ruling that backed the 2014 CMS regulation requiring swift return of overpayments.

article thumbnail

Humana sues HHS over Medicare Advantage audits

Healthcare Dive

The payer, which brings in the bulk of its revenue from Medicare, is fighting back against a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.

Medicare 294
article thumbnail

Inspector General pushes CMS to recover $226M in Medicare overpayments

Modern Healthcare - Policy

An OIG audit outlined millions in uncollected overpayments, holes in internal accounting system

article thumbnail

Understanding Medicare Coordination of Benefits (COB)

Medisys Compliance

When a healthcare provider treats a patient who has Medicare as well as another type of health insurance, understanding the rules for Medicare Coordination of Benefits (COB) becomes essential. What is Medicare Coordination of Benefits? Medicare is primary if the employer has fewer than 20 employees.

article thumbnail

Five Tactics for Payers to Succeed in Value-Based Care

MRO Compliance

The Centers for Medicare & Medicaid Services (CMS) has set a bold goal : by 2030, all Medicare beneficiaries and the majority of Medicaid beneficiaries must participate in value-based payment models. This shift represents one of the most ambitious overhauls in U.S.