Hall Render
JANUARY 12, 2023
On December 27, 2022, the Centers for Medicare & Medicaid Services (“CMS”) published a proposed rule that could potentially have a significant impact on enrollees’ obligations under the “60-day” overpayment rule. In fact, claims reviews to quantify an overpayment is a time-consuming effort and the six-month period is necessary.
Healthcare IT News - Telehealth
JUNE 8, 2022
Additionally, any reimbursement resulting from these claims could be considered an overpayment. Once a provider has credible evidence of an overpayment, it must be reported and returned to avoid triggering FCA liability. If Medicare coverage requirements for telehealth services (e.g.,
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YouCompli
FEBRUARY 22, 2023
They found the facility correctly billed 17 of the 120 but incorrectly billed the remaining 103 claims, which totaled over $580,000 in overpayments. The facility discovered this on one claim but ultimately found an additional 26 claims where this same charge error was present. Return illegitimate reimbursement and overpayments quickly.
Health Care Law Brief
APRIL 3, 2023
A key focus of the MA risk adjustment model is to accurately predict costs that are attributable to characteristics that are present over time (e.g., In the Advance Notice, CMS predicted that the changes to the risk scores and HCC updates will help prevent overpayments by improving the accuracy of payments made to MAOs. See 88 Fed.
Healthcare IT Today
FEBRUARY 22, 2023
CMS requires chart reviews to catch overpayments. Each patient is evaluated to determine how much risk they present. Figure 1: Dashboard showing a breakdown by year Chart reviews are independent examinations of patients’ clinical records. They’re valuable for many reasons.
Med-Net Compliance
OCTOBER 21, 2022
The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries. Excluded individuals and entities are listed in the OIG’s exclusions database.
Medisys Compliance
MARCH 7, 2022
This occurs when the sheer quantity of the displayed items seems wildly disproportionate to the nature of the presenting problems. Your notes should always have an interval history of present illness (HPI). In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first.
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