Claims Compliance & Processing: Understanding the High-Risk Area
Key Points: Claims development and submission was highlighted as a primary compliance high-risk area by the Department of Health and Human…
Bipartisan Group of Senators Proposes Amendments to False Claims Act
Key Points: Amendments would result in significant modifications to statutory language. Burden of justifying dismissal of cases would be codified.…
CMS Releases January 2019 Hospital OPPS Update
The Centers for Medicare & Medicaid Services (CMS) recently published a Medicare Learning Network (MLN) Matters article that outlines January…
GAO Report on Data Analytics for Oversight and Law Enforcement
Overview Over the years, the Department of Health and Human Services Office of Inspector General and the Centers for Medicare…
CMS Finalizes Payment and Policy Changes for Home Health Agencies
The Centers for Medicare & Medicaid Services (CMS) recently finalized payment and policy changes for Home Health Agencies (HHAs) and…
CMS and VA Announce Partnership to Address Fraud, Waste, and Abuse.
The Department of Veterans Affairs (VA) and the Centers for Medicare & Medicaid Services (CMS) recently announced a partnership designed…
CMS Issues Proposed Rule Updating the Home Health Prospective Payment System.
The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule updating the Medicare Home Health Prospective Payment System…
District Court Orders End of Medicare Claims Appeal Backlog by 2020.
The United States District Court for the District of Columbia recently ordered the Department of Health and Human Services (HHS)…
OIG Issues Report on Improper Claims for Deceased Individuals.
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released a study evaluating policies and…
Validity versus representativeness
The terms “validity” and “representativeness” are often referred to when assessing claims payment and over-payment in healthcare. Confusion about their…
CMS Commences Round 2 Settlement Process for Inpatient Claims.
The Centers for Medicare & Medicaid Services (CMS) recently announced Round 2 of the settlement process for denied inpatient claims.…
CMS Issues CY 2015 OPPS and ASC Final Rule
The Centers for Medicare & Medicaid Services (CMS) recently issued the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center…