YouCompli

MARCH 22, 2023

There has been significant enforcement over the last couple years relating to overpayments for UDT. In general, there are two major categories of UDT. The overpayment rate for definitive drug testing for 22 or more drug classes was over 71%. What do all these entities and settlements have in common? What is Urine drug testing?

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Hall Render

FEBRUARY 14, 2023

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. Background RADV audits are the main tool that CMS uses to correct overpayments made 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

This Rate Announcement follows CMS’s February 1 notice of planned changes to rates and the risk adjustment methodology, which provided an opportunity for the public to submit comments during a 30-day period (Advance Notice), as required by Section 1853(b)(2) of the Social Security Act (the Act). diabetes, depression, heart disease).

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare IT Today

FEBRUARY 2, 2023

In turn, this should also build more meaningful connections between providers and members as they work together to document and promote patient health. Target audits highlight areas for provider education. You can audit by condition, individual provider, demographic, provider group, or facility.

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

YouCompli

DECEMBER 14, 2022

We are trained professionals tasked with protecting the organization from risk and supporting the mission of providing excellent patient care. As much as possible, offer specific examples of what is ok, what is not, and the “why” behind each category. If so, can they provide a step counter to enrollees in the program?

Compliance 52

Compliance Compliance Officers Nurses Overpayments 52