Posts Tagged ‘CMS’
CMS’ fraud crackdown relies on high-tech analytics
The government’s crackdown on Medicare fraud is paying off and healthcare providers that bill the government program would be well advised to know that the Centers for Medicare & Medicaid Services is using a high-tech analytics system to identify inappropriate payments. Aptly named the “Fraud Prevention System,†the program has identified or prevented $820 million…
Read MoreCMS to cut providers a break when it comes to ICD-10 deadline
With the implementation of ICD-10 just around the corner (Oct. 1) comes word from the Centers for Medicare & Medicaid Services that it will not deny claims made under the Part B physician fee schedule if there are coding errors. The guidance notice, which was issued with the blessing of the American Medical Association, is…
Read MoreCMS releases final rule for Medicare Shared Savings Program ACOs
The Centers for Medicare & Medicaid (CMS) earlier this month released its much- anticipated Final Rule updating the Medicare Shared Savings Program. The whole concept behind the program, created by the Affordable Care Act (ACA), is to encourage participation among providers through the use of accountable care organizations (ACOs). ACOs are groups of providers that…
Read MoreCMS unveils proposed rules for Medicaid managed care plans
On May 26, The Centers for Medicare & Medicaid Services (CMS) released its long-awaited proposed rule, updating its Medicaid managed care organization regulations. The proposal is designed to “better align regulations and best practices to other health insurance programs, including the private market and Medicare Advantage plans, to strengthen federal and state efforts at providing…
Read MoreOIG cracks down on place-of-service overpayments
Is your practice using proper place-of-service codes? If not, you’re not alone. According to a new report from the HHS Office of Inspector General, Medicare contractors may have overpaid physicians to the tune of $33.4 million for incorrectly coded services provided between January 2010 and September 2012. Why? It appears that the services were performed…
Read MoreHome healthcare agencies, aides top fraud list
Home healthcare agencies and home healthcare aides topped the list of providers with the largest number of healthcare fraud convictions in 2014, according to a report released last month by the HHS Office of the Inspector General. Of the more than $1.9 billion recovered in total civil judgments and settlements, the federal government recovered $186…
Read MoreGAO: Government misspent billions on Medicare/Medicaid
Last year, Medicare financed health services for approximately 54 million elderly and disabled beneficiaries at a total cost of $603 billion. Of that, approximately $60 billion went toward improper payments, according to a report issued last week by the Government Accountability Office (GAO) Most of that misspent money, about $45.8 billion, went toward the Medicare…
Read MoreCMS says ICD-10 testing successful: Are you prepared?
The Centers for Medicare and Medicaid Services is reporting that it successfully completed the first week of end-to-end testing of the soon-to-be-implemented ICD-10 coding. The testing, which took place between Jan. 26 and Feb. 3, included 661 participants with about 1,400 National Provider Identifiers registered. They were split equally between direct submitters and clearing houses/billing…
Read MoreGAO: CMS ready for ICD-10, but are you?
There is good news for healthcare providers coming out of the Government Accountability Office: The Centers for Medicare and Medicaid Services is prepared for the switch to ICD-10 on Oct. 1, according to a newly released report. The 41-page report notes that CMS has undertaken “a number of efforts†to prepare for transition to the…
Read MoreCMS extends moratoria for home health agencies, ambulance suppliers
The Centers for Medicare and Medicaid Services (CMS) is continuing its crackdown on fraud and abuse and South Florida providers are, not surprisingly, on its hit list. CMS announced on Jan. 30, new temporary moratoria on the enrollment of home health agencies in four cities including Fort Lauderdale. It also is extending, for another six…
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