CMS has released a pair of rules “that take historic steps to increase price transparency to empower patients and increase competition among all hospitals, group health plans and health insurance issuers in the individual and...more
Highlighting the US Department of Health and Human Services’ (HHS) efforts to transform the US healthcare system to a value-based model, the Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid...more
In keeping with its recent recommendations to CMS, the Office of Inspector General for the US Department of Health and Human Services (OIG) is recommending increased oversight and compliance reporting requirements for...more
For those providers—and there are more than a few—that believe the administrative and regulatory burdens associated with participating in the Medicare and Medicaid programs negatively affect their ability to furnish...more
A new update to the Medicare Program Integrity Manual offers healthcare providers and suppliers more details on how Medicare contractors should perform statistical sampling and when extrapolation of overpayment determinations...more
The Office of Inspector General Portfolio Report is a rehash of the watchdog agency’s 2006–2016 findings on quality of care concerns and program integrity issues. The report, which garnered some critical press attention for...more
Key themes emerging from the hundreds of pages of proposed Medicare payment and policy rules impacting hospitals and post-acute providers include encouraging price transparency, promoting exchange of healthcare data, and...more
The Centers for Medicare & Medicaid Services recently expanded its national audit strategy, titled “Targeted Probe and Educate,” for Medicare billing review after pilot programs with four Medicare Administrative Contractors...more
Hurricanes Harvey and Irma have led to the declaration of a public health emergency in various affected areas across the country. As healthcare providers continue to provide essential disaster response operations, CMS and HHS...more
The report shows significant lapses in 2012 GIP service claims and recommends that CMS implement additional oversight and enforcement options....more
Follow these tips to ensure compliance in the wake of the new 60-Day Rule.
On February 12, the CMS finalized the 60-Day Overpayment Report and Refund rule (60-Day Rule) for Medicare Parts A and B. This long-awaited rule...more
The final rule relaxes the requirements on “identification” and look-back period.
The Centers for Medicare & Medicaid Services (CMS) has released its long-awaited final rule related to the reporting and refunding of...more
The court’s interpretation complicates the already difficult task providers face in having sufficient time to assess and quantify potential overpayments.
An August 3 decision in United States v. Continuum Health Partners...more
8/6/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare ,
Hospitals ,
Medicaid ,
Medicare ,
Overpayment ,
Qui Tam ,
Relators
Although CMS has not yet issued a final rule on the ACA’s 60-day repayment provisions, hospitals and other providers can still create policies and train staff in a manner that gives them some measure of protection. Even with...more
6/3/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Chief Compliance Officers ,
Compliance ,
Health Care Providers ,
Hospitals ,
Medicaid ,
Medicare ,
Medicare Part A ,
Medicare Part B ,
Overpayment
The OIG’s recently released study examining Medicare hospice claims from 2007 to 2012 calls for targeted reviews of hospices that receive a high proportion of their payments for care in assisted living facilities....more
CMS reconsiders $10 million bounties for reporting of regulatory violations.
On December 5, the Centers for Medicare & Medicaid Services (CMS) finalized a rule (the Final Rule) that expands its program integrity and...more
Hospices will be expected to be more vigilant in their decisions to cover and pay for prescription medications covered under their Medicare hospice per diem payment.
On December 6, the Centers for Medicare & Medicaid...more
Final rule aims to improve the quality and consistency of care between long-term care facilities and hospice providers but may increase conflict between facility and provider staff.
...more
OIG continues its aggressive interpretation of scope and effect of exclusion from participation in Federal health care programs and clarifies several open questions....more
Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority.
On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more
CMS and OIG issue similar proposed rules to modify the electronic health record exception and safe harbor.
On April 10, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) of...more