Search Results for: eight elements

Home Health Providers Under the Microscope — The Review Choice Demonstration Project is Here

Home Health & Hospice /

(October 4, 2018): Last week, the Centers for Medicare & Medicaid Services (CMS), confirmed that it intends to initiate the Review Choice Demonstration for Home Health Services project on December 10, 2018.  The Review Choice Demonstration project is slated to initially begin in Illinois. This initiative is the renamed, repackaged version of the prior Pre-Claim […]

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NBI MEDIC Referrals to Boards, OIG and DOJ are Here!

Medicare, Medicaid & Private Payor Updates /

(June 28, 2017): The Medicare program is enormous. As of 2016, more than 56 million individuals participated in the program, with more than 10,000 additional individuals enrolling in the program each day. The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for managing this costly program. To direct this $640 billion program,

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Dental Practice Audits are on the Rise — Protect your Interests!

Dental Audits & Compliance /

(October 11, 2016): More than 45 million children receive government-funded dental care served under Medicaid and CHIP programs. This equates to approximately 1 out every 3 children in the country. The dental care provided includes screening services and other preventive, diagnostic, and treatment services that are medically necessary and properly documented. Under the mandatory Early

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CMS and Contractors Must Address EHR Fraud Vulnerabilities

Medicare, Medicaid & Private Payor Updates /

(February 7, 2014): A new report from the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) finds that the Centers for Medicare and Medicaid Services (CMS) and its contractors have adopted few Medicare program integrity practices to address electronic health record (EHR) fraud vulnerabilities. These EHR fraud vulnerabilities include

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EHR Cloning Practices Can Lead to Medicare Audits

Medicare, Medicaid & Private Payor Updates /

(December 26, 2013): The Department of Health and Human Services (HHS) has long viewed the adoption of Electronic Health Records (EHRs) as a way to better coordinate care, improve the quality of care, reduce unnecessary paperwork, and eliminate duplicative medical testing. Based, at least in part, on these beliefs, Congress authorized incentive payments to encourage

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PERM Audits of Medicaid, Managed Care and CHIP Claims are Ongoing. Are You Prepared to Respond to a PERM Audit?

Medicare, Medicaid & Private Payor Updates /

Author: Ashley Morgan, Annabella Denzel (September 28, 2023): Providers participating in the Medicare and Medicaid programs are currently subject to audit by numerous Federal and State regulatory and law enforcement agencies. Additionally, the Centers for Medicare and Medicaid Services (CMS) has entered several contractual arrangements with private contractors to handle various aspects of administrative integrity

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The OIG Found that More than Half of All Power Wheelchair Claims Paid by Medicare were Improper.

Medicare, Medicaid & Private Payor Updates /

(July 16, 2011): As Zone Program Integrity Contractor (ZPIC) audits of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) companies continue to climb, the Department of Health and Human Services, Office of Inspector General (HHS-OIG), has now reported that more than one-half of the recent power wheelchair claims by Durable Medical Equipment (DME) suppliers were

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HHS-OIG Report Signals an Increase in SNF Audits by ZPICs

Medicare, Medicaid & Private Payor Updates /

(April 1, 2011): Skilled Nursing Facilities (SNFs) are again in the spotlight. A recent report likely signals an increase in future SNF Audits. The Prospective Payment System (PPS) under which SNFs are reimbursed by Medicare has long been criticized by many concerned with “benefit integrity” and curbing waste, fraud, and abuse in the Medicare program.

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