Whistleblower Alleges MA Plans Overstated Risk, Overcharged Medicare
A whistleblower action brought by a former Medicare Advantage (MA) plan executive alleges that two MA plans in Puerto Rico systematically inflated members’ risk adjustment scores to indicate that the...
View ArticleICD-10 Delayed Until October 1, 2015, May Add $1B to $6.8B in Costs
The deadline for the implementation of ICD-10 has been extended for one year to October 1, 2015, according to the advance release of an HHS final rule. Required by the Protecting Access to Medicare Act...
View ArticleCMS Urged to Reimburse Providers for End-of-Life Planning
Should Medicare and Medicaid reimburse providers for counseling patients regarding end-of-life issues? Support for Medicare and Medicaid reimbursement for end-of life planning has been growing from a...
View ArticleHighlight on North Carolina: NC ramps up for ICD-10, provides fun coding facts
NCTracks, a new multi-payer Medicaid Management Information System for the North Carolina Department of Health and Human Services (NC-DHHS) has used a “RAMP UP to ICD-10” project to assist provider...
View ArticleProviders still have time to prepare for ICD-10, say experts
There is still time to prepare for International Classification of Diseases, Tenth Revision (ICD-10) before the October 1, 2015 implementation date, presenters emphasized during the MLN Connects...
View ArticleMedPAC votes to recommend recalculation of MA benchmarks
The Medicare Payment Advisory Commission (MedPAC) unanimously voted to recommend that the HHS Secretary modify the calculation of Medicare Advantage (MA) benchmarks. The recommended change, discussed...
View ArticleCompliance advice offered to providers in the orthotic and prosthetic arena
There are high clinical documentation standards for orthotic and prosthetic (O&P) providers. Non-compliance with these documentation requirements can result in numerous adverse consequences for...
View ArticleFlorida hospital improperly billed Medicare almost $300,000 over two years
For over two years, University of Florida Health Jacksonville did not comply with Medicare billing requirements, due to inadequate billing controls. The noncompliance resulted in overpayments of at...
View ArticleCMS delays implementation of bundled payment models
CMS has further delayed the implementation date of the Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the Comprehensive Care for Joint Replacement (CJR) model by three months....
View ArticleKusserow on Compliance: CMS improperly paid $367M for outpatient physical...
The OIG issued an audit report that found sixty-one percent of Medicare claims for outpatient physical therapy services reviewed did not comply with Medicare medical necessity, coding, or documentation...
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