Medicare Compliance & Reimbursement
THREE-DAY INPATIENT STAY RULE VEXES SNFs, FEDS
The OIG thinks nursing homes are bungling hospital stay data The HHS Office of Inspector General has its eye on the issue, and is hunting for errors at a number of Medicare contractors. In its latest review, "Ineligible Medicare Payments to Skilled Nursing Facilities Under the Administrative Responsibility of Veritus Medicare Services" (A-05-03-00035), the watchdog agency estimates that Medicare paid more than $6.3 million worth of overpayments that ought to be recovered. The errors occurred because the Centers for Medicare & Medicaid Services systems' don't have an automated cross-check to verify that a three-day inpatient hospital stay occurred prior to SNF admission - a requirement for eligibility. In the OIG's view, it's clear that SNFs are entering inaccurate hospital stay information, and the watchdog agency urges Veritus to pursue the overpayments. To see the report, go to http://oig.hhs.gov/oas/reports/region5/50300035.htm. Lesson Learned: Avoid overpayment demands by making sure your staff fills in correct hospital stay data on your Medicare claims.
Skilled nursing facilities whose staffers don't enter accurate hospital stay data on their Medicare claims will likely end up facing overpayment demands down the road.
Medicare Compliance & Reimbursement
- TENET FACES MORE SCRUTINY OF PHYSICIAN RELATIONSHIPS
This time, state fraud fighters in Florida are investigating the hospital chain.
Fraud fighters are paying [...] - MEDICARE PAY CUT LOOMING IN 2004
Only a few months after Congress turned a looming 4.4 percent Medicare pay cut into [...] - Dozens of Physician Procedures Slashed in 2004 Fee Schedule
99311, 45385, 99348 among hardest hit.
Physicians who see lots of patients in the nursing home [...] - ELECTRONIC CLAIMS EXCEPTIONS FEW AND FAR BETWEEN
Providers should get ready to go electronic with their Medicare claims.
When the Health Insurance Portability [...] - Top 4 Bases for Liability Under the False claims act
Learn these federal no-nos and prevent unwitting fraud.
When the government cracks down on False Claims [...] - EVERYONE DISLIKES AWP, BUTDOCS DISLIKE PROPOSED FIXES
Medicare beneficiaries and the government could save up to $45.2 billion over ten years if [...] - CMS SEEKS COMMENT ON FOUR PAYMENT SCHEMES
According to the Centers for Medicare & Medicaid Services, increasing practice expense reimbursements is irrevocably [...] - THREE-DAY INPATIENT STAY RULE VEXES SNFs, FEDS
The OIG thinks nursing homes are bungling hospital stay data
Skilled nursing facilities whose staffers don't [...] - Medicaid Probe Drives Supplier Out Of Business
DME suppliers should repeat this mantra: documentation, documentation, documentation.
A recent investigation focusing on three compliance [...] - HEALTH CARE EXECS BEWARE
Post-Enron hostility to corporate fraud takes its toll on a lab exec.
The growing disgust with [...] - FEDS SEEK INFO ON BRISTOL-MYERS COMPLIANCE REVIEW
Internal review covers sales, marketing and pricing practices.
As government scrutiny builds on pharma companies' sales [...] - ONLINE MEDICARE RESOURCES GET A LITTLE LESS COMPLICATED
CMS unsnarls a tangled web.
Confused by the sometimes-labyrinthine experience of navigating the Centers for Medicare [...] - M+C benes Spending More, But FFS Benes Spending even More
The average Medicare+Choice enrollee is spending about $1,964 out-of-pocket this year, 10 percent more than [...] - PROGRAM MEMO ROUNDUP
The interest rate for Medicare overpayments and underpayments went up August 11, rising from 11.625 [...]
