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 »
Over a nine-year period, from 2001 to 2010, physicians increased billing of higher level evaluation and management (E/M) codes in all types of E/M services, according to an Office of the Inspector General (OIG) report released in May...Read More »
The Office of the Inspector General (OIG) pointed to deficiencies in CMS’ oversight of Zone Program Integrity Contractors (ZPICs), indicated that Comprehensive Error Rate Testing (CERT) program calculations could be more accurate, and pointed to unaddressed contractor-identified vulnerabilities...Read More »
Review Medicaid Integrity Contractors (MICs) completed 81% of their CMS assignments resulting in potential $282 million in possible recoveries for Jan. 1, 2010, to June 30, 2010, according to a February OIG report...Read More »
