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 »
CMS’ three-day rule defines certain preadmission services as inpatient operating costs, meaning they are bundled and billed as part of the inpatient claim and payment is made as part of the applicable DRG payment for the case. This sounds simple, and there had been very little new guidance for...Read More »
A Maryland hospital allegedly added malnutrition as a secondary diagnosis, employing tactics that included the submission of leading queries to increase reimbursement, according to...Read More »
