A recent report by the Department of Health and Human Services Office of Inspector General shines a light on significant billing issues for neurostimulator implantation surgeries. READ MORE
The Program Integrity unit of Indiana’s Office of Medicaid Policy and Planning has implemented a new program to reduce costs related to improper payments. The Targeted Probe Education, or TPE, program, designed by CMS, began August 20, 2021. READ MORE
Beginning in March, the Centers for Medicare and Medicaid Services will release Comparative Billing Reports to some providers who perform anesthesia services. READ MORE
Indiana Medicaid providers who are identified for Program Integrity Audits can respond to audit letters using the Indiana FADS Secure Portal. And a new online training module from IHCP, Indiana FADS Secure Portal Tutorial, will give providers, staff members, or other representatives the information they need to use the system. READ MORE
Medicare will soon begin replacing beneficiaries’ social-security-based Health Insurance Claim Number with new randomly-assigned Medicare Beneficiary Identifiers (MBI) to help protect against fraud and identity theft. Congress mandated the change through the Medicare Access and CHIP Reauthorization Act (MACRA) with an April 2019 deadline. READ MORE
Beginning August 1, 2016, penalties under the False Claims Act have almost doubled. READ MORE
The Office of Inspector general is recommending that the Centers for Medicare and Medicaid Services (CMS) eliminate the “provider-based facility” place of service designation because there is no reliable way to track or audit payments or potential overpayments. READ MORE
In a recent ICD-10 Monitor article, Bonnie Cassidy, vice president of consulting for Precyse MedAssets, claimed that the best way to get a handle on the growing number of denials under ICD-10 is for various players along the revenue cycle to “work collaboratively to design and deploy … a new pre-bill review process.” READ MORE
Starting April 18, 2016, Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) conducting redeterminations and reconsiderations of denied claims must limit their review to the reason the claim or line item at issue was initially denied. READ MORE
The Health and Human Services Office for Civil Rights (OCR) has begun its Phase 2 Audits of covered entities and their business associates under the HIPAA Privacy, Security and Breach Notification Rules. READ MORE
