Insufficient documentation is by far the most common reason for denying a claim or improperly paying a claim. Improperly paid claims become problematic after identification by the Center for Medicare and Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT), a random sampling of claims evaluated for compliance with Medicare coverage, coding and billing rules.
Are you planning to participate in MIPS? Take a look at our infographic to learn more about how it might impact your reimbursement.
CMS announced their 2017 CAHPS survey, and time is running out for providers to submit their participation applications. Qualified applicants will be awarded points toward their MIPS status. Review our infographic to learn more about the survey process!
Just like no two snowflakes are identical, no two healthcare facilities are the same. CMS has provided a series of compare websites and checklists to help patients make informed decisions regarding their healthcare needs. Familiarize your organization with these lists in order to help make sure you meet all of the recommended criteria! Over
On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule implementing the MACRA Quality Payment Program. Most providers following the traditional Medicare payment model will now be using the Merit-based Incentive Payment System (MIPS). CMS estimates approximately 500,000 clinicians will be eligible to participate in MIPS in the first year of
The Center of Medicare and Medicaid Services’ (CMS) Nursing Home Compare website offers a Five-Star Quality Rating System to help consumers make informed decisions about nursing home choice based on quality. The top 10% of nursing homes in each state will receive a five-star rating and the lowest 20% will receive a one-star rating. In
Fighting fraud, waste and abuse continues to be the focus of the Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG). Almost 80 percent of HHS’ budget is spent on Medicare, Medicaid and CHIP totaling near $985 M for FY 2015. The ongoing goal for Center for Medicare and
Have you had the opportunity to read the 962-page proposed rule from Centers for Medicare and Medicaid Services (CMS) regarding changes to physician payments? This lengthy document echoes the same goal throughout, create an “innovative, outcome-focused, patient-centered, resource-effective health system.” For a provider, big changes are ahead. As part of the Medicare Access and CHIP Reauthorization
Protecting the integrity of the Medicare program is a top priority. Fortunately, the Affordable Care Act has allotted significant funding for task forces to root out fraud, waste and abuse. Up until now, the task forces have focused recovery efforts on funds already paid to the providers and suppliers. The new focus is on prevention
The long awaited ruling on reporting and returning overpayments is now in the Federal Register and will become effective on March 14, 2016. As stated in §401.303, an overpayment is any fund that a person has received or retained under Title XVIII of the Social Security Act to which the person, after applicable reconciliation, is