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The payment rate was way up, while the HHA error rate was down. If you’re wondering how much review pressure your hospice is likely to encounter this year, Medicare’s recent Comprehensive Error Rate Testing (CERT) report may tell you. Hospices clocked in with a 12.04 percent improper payment rate for 2022, equaling an estimated $ 2.9 […]
The post Hospices’ CERT Improper Payment Rate Up In 2022 appeared first on AAPC Knowledge Center.
Two chiropractic practices agree to pay over $ 800,000 to resolve liability for the alleged improper billing of P-Stim devices. In the latest case of improper billing of P-Stim electro-acupuncture devices, two integrated chiropractic practices and their owners have agreed to pay $ 805,978 to resolve liability under the False Claims Act. This case comes on the […]
The post Improper Billing of P-Stim Devices Leads to More Fraud Settlements appeared first on AAPC Knowledge Center.
MACs may be applying the multiple endoscopy rule incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endoscopic procedures to the family of functional endoscopic sinus surgery (FESS) codes. Real-world Scenario Practices are now getting […]
The post Check Your FESS Claims for Improper Payment Adjustments appeared first on AAPC Knowledge Center.
For quite a long time, Medicare and Medicaid have been included on a Government Accountability Office (GAO) rundown of government programs that are at an expanded danger of misrepresentation, waste, misuse, and bungle. GAO’s investigations of FY 2017 program activities that gauges $ 27.5 billion in inappropriate installments implies it will probably make the rundown again in one year from now’s report.
The GAO is an autonomous, neutral organization that works for Congress. Frequently called the “congressional guard dog,” GAO inspects how citizen dollars are spent and furnishes Congress and government organizations with reports to help survey the administrative government’s execution. As indicated by the report, the GAO appraises that Medicare expense for-administration made $ 23.2 billion in inappropriate installments while Medicaid made $ 4.3 billion.
To build up these assessments, CMS utilizes temporary workers to review an example size of cases. The reviews incorporate medicinal documentation audits to approve restorative need and adherence to CMS charging approaches. The contractual workers extrapolate patterns from the examples to extend the by and large ill-advised installment rate.
The report characterizes lacking documentation as “ill-advised installments in which suppliers submit documentation that is inadequate to decide if a case was legitimate, for example, when there is deficient documentation to decide whether administrations were medicinally important, or when a particular, required documentation component, for example, a mark, is absent.”
As per the GAO, inadequate documentation was referred to as the reason for 64 percent of Medicare and 57 percent of Medicaid inappropriate installments. Information from CMS uncovered that the general rate of deficient documentation over all administrations in FY 2017 was 6.1 percent for Medicare versus 1.3 percent in Medicaid. The report concentrated on this difference.
The GAO report likewise incorporates suggestions to CMS for improving the therapeutic audit procedure to all the more likely comprehend the ill-advised installment rate.
The post GAO Scrutinizes Insufficient Documentation as Cause for Improper Medicare and Medicaid Payments appeared first on The Coding Network.
Cardiovascular Associates, P.C. has consented to pay $ 399,230.35 to settle asserts that they submitted false cases to the United States for administrations not rendered. Cardiovascular Associates P.C. is a therapeutic practice with workplaces situated in Rockville, Olney, Laurel and Germantown, Maryland.
The post Cardiovascular Associates, P.C. Consents to Pay the United States Over $ 399,000 to Settle False Claims Act Allegations Relating to Improper Billing Practices appeared first on The Coding Network.
The Office of Inspector General (OIG) reviewed 191,118 Medicare paid distant-site telehealth claims, totaling $ 13.8 million, that lacked corresponding originating-site claims. The watchdog agency then reviewed provider supporting documentation of these claims to determine if the services met Medicare’s requirements for reimbursement. 31% of the telehealth claims did not.
Now is the time to fully understand Medicare telehealth claim requirements and nail down its coding, and documentation rules. Why? Because CMS is planning for a major coverage hike of telehealth services in 2019—as well as a boost in telehealth pay!
Bank on TCI’s all-new, end-to-end Telemedicine & Telehealth Handbook for Medical Practices 2018 to equip you to plan and implement your telehealth services, weigh the cost of care and technology, and master payment aspects, compliance, and other legal requirements.
Our experts take the guesswork out of best practices and government regulations, laying out in-depth information on Medicare and Medicaid reimbursement. Capitalize on insightful answers to readers’ questions. Get the inside scoop on coding, billing, compliance, and everything between to launch your telehealth services without a hitch.
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The post OIG Estimates Medicare Improper Payments at $ 3.7 million appeared first on The Coding Network.
Debra Conrad, a medical coder sued Mosaic Life Care Medical Center in St. Joseph, Mo., May 25 for wrongful discharge, unlawful retaliation and age discrimination. She alleges Mosaic Life Care fired her for disclosing the hospital’s fraudulent billing practices.
Click here for the full story!
The post Missouri hospital allegedly fired coder for refusing to ignore improper billing appeared first on The Coding Network.
Massachusetts Attorney General Maura Healey announced today a settlement with a pediatric dentist in Springfield. Healey’s office returned $ 500,000 to MassHealth, the state’s Medicaid program, resolving claims that improper billing for services occurred.
The post Due to Improper Billing, Healey Returns $ 500,000 in Settlement With a Springfield Dentist appeared first on The Coding Network.