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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
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
Posted in Academy Blog
Tagged appeal academy, auditing in healthcare, audits in healthcare, clinical audits, health audit, healthcare audits, inpatient, IPPS, medical audit, medical auditors, medical audits, medicare appeal, medicare audit, Medicare Part B, Medicare Part D, opps, outpatient, sad, self-adminstered drug
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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
Posted in Finally Friday!
Tagged appeal academy, audit in healthcare, audit tools for healthcare, audit tools in healthcare, auditing in healthcare, audits in healthcare, clinical audit cycle, clinical auditing, clinical audits, finally friday, healthcare audits, inpatient, internal audit procedure, IPPS, medical audit, medical auditors, medical audits, medicare appeal, medicare audit, MOON, moon notice, NOTICE, NOTICE Act, opps, outpatient
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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
Posted in Academy Blog
Tagged 2mn rule, BFCC-QIO, CMS, cms rac, healthcare audit, kepro, livanta, medical audit, medicare audit, QIO, two midnight rule
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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
Posted in Industry News
Tagged appeal academy, inpatient, inpatient status, IPPS, medical audit, medicare audit, moon notice, NOTICE Act, observation service
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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
Posted in Academy Blog
Tagged appeal academy, inpatient, inpatient status, IPPS, medical audit, medicare audit, moon notice, NOTICE Act, observation service
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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
Posted in Academy Blog
Tagged center for public integrity, CMS, Medicare Advantage Plans, medicare audit, radv, risk score
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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.
