Tag Archives: medicare audit

Nominee Tom Price Wants Shift Away from Medical Necessity Audits To Anti-Fraud Audits

CMS should focus its billing audits less on verifying medical necessity and more on rooting out blatant fraud, the agency’s likely next secretary said Tuesday. Rep. Tom Price, R-Ga., made statements to that affect while appearing before the Senate Finance … Continue reading

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Self-Administered Medication – Earned Revenue or Another Write Off

Caveat emptor et provisor [Let buyer and provider beware] Written by Bill Malm, ND CMAS CRCR Many facilities struggle with the implementation and collection of earned revenues from Self-Administered Medications (SAD.)  SAD has had a litany of guidance made by … Continue reading

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“Finally Friday!” CMS Proposes the MOON & Other Changes for the NOTICE Act

FRIDAY May 13, 2016: “CMS Proposes the MOON & Other Changes to Implement the NOTICE Act“ A Proposed Rule Inside A Proposed Rule OR How CMS can defy Congress with a straight face Get the Handouts Sponsored by The Health … Continue reading

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CMS Temporarily Pauses Two-Midnight Reviews by QIOs

Reasoning Unclear, Time-frame Indeterminate Audits of Medicare claims concerning the Two-Midnight Rule are temporarily suspended by CMS, to allow CMS to collaborate with the two BFCC-QIO contractors, Livanta and KEPRO, “to ensure consistency in how the rule is applied to … Continue reading

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CMS Proposes MOON for the NOTICE Act in FY2017 IPPS Proposed Rule

One of many changes floated in the FY2017 IPPS Proposed Rule CMS introduced a standard notice to be given to observation patients after 24 hours as such, the “Medicare Outpatient Observation Notice” (MOON) that would include all of the informational … Continue reading

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CMS Offers the MOON to fulfill NOTICE requirements

CMS has developed a standard notice, the “Medicare Outpatient Observation Notice” (MOON) that would include all of the informational elements necessary to fulfill the NOTICE Act’s written notice requirement. Continue reading

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Federal Audits Of Medicare Advantage Reveal Widespread Overpayments

CMS Seems Loathe to Reveal the Data Four Medicare Advantage audits were recently revealed courtesy of a Freedom of Information Act lawsuit filed by the Center for Public Integrity (CPI), adding to growing concern that yet more significant billing errors … Continue reading

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“Finally Friday!” Review: The Physician Advisor & UR Team Boot Camp

This session was recorded on Friday, July 26, 2013. Today’s show is an overview of some of the talks we heard at the PA Boot Camp, with a review of some of the key talks, including video snippets from them.

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