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CMS Issues Long-Awaited Medicare Advantage RADV Final Rule

Healthcare Law Blog

Statutory and Regulatory Authority : CMS cited its statutory authority to audit providers and recoup improper payments under the Medicare statute. Likewise CMS cited its fiduciary duty to protect taxpayer dollars from overpayments and its fiduciary responsibility to recover funds due to the Medicare Trust Funds. Becerra et al.,

Medicare 105
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Compliance Risks Associated with Outlier Payments 


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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Government Watchdogs Attack Medicare Advantage for Denying Care and Overcharging

Kaiser Health News

They also called for the Centers for Medicare & Medicaid Services, or CMS, to revive a foundering audit program that is more than a decade behind in recouping billions in suspected overpayments to the health plans, which are run mostly by private insurance companies. Bliss said Medicare paid $2.6

Medicare 107
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Enhancing Payment Integrity in Healthcare through Pre-Payment Reviews

Healthcare IT Today

Payers battle administrative overload caused by reconciling inaccurate payments and reprocessing claims to pay the accurate reimbursement amount. This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected. In adopting pre-payment systems, the synergy between payers and providers is paramount.

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Home Health PPS Proposed Rule for CY2023: More Bad News for the Home Health Industry

Hall Render

On Friday, June 17, 2022, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2023 Home Health Prospective Payment System Rate Update (“PPS Rule”). CMS states a temporary adjustment is necessary to offset this overpayment. That file may be accessed here.

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Health Provider News

Hall Render

Million Hospital Will Bridge Western Wyoming Health Care Gap Gillette representative’s healthcare legislation signed into law The post Health Provider News appeared first on Law Firm | Health Care Law Firm in the USA | Hall Render.