In two recent findings from the Office of the Inspector General (OIG), improper documentation may have led to inaccurate claims submission and associated payments....Read More »
CMS issued new guidance last week aimed at clarifying the so-called “two-midnight rule” finalized in the 2014 IPPS. The rule essentially states that physicians should order an inpatient admission if he/she expects the care...Read More »
Although Recovery Auditors have identified more than a billion dollars in inappropriate payments, CMS needs to do more to improve its oversight of the program, and target potential instances of fraud identified by the program,...Read More »
When CMS stopped paying for healthcare-associated infections such as catheter-associated blood stream infection and urinary tract infections, the agency expected rates for such infections to decline. In fact a recent study “found no evidence that the 2008 CMS policy had any measurable effect on...Read More »
Q: What are the ramifications of leading queries? Who is monitoring whether a query is leading?
A: I am unaware of any organization or agency routinely monitoring physician queries. However, regular query review for compliance with existing industry guidelines, reflection of appropriate...Read More »
A recent Office of the Inspector General report found PacifiCare of Texas received $115 million in CMS overpayments. The OIG reviewed 100 sample cases and found 43 claims with incorrect payments. According to the report,...Read More »
