In fiscal year 2016, 65% of providers were subject to prepayment review associated with the CMS Fraud Prevention System, according to a report by the United States Government Accountability Office (GAO).
In the 2018 OPPS proposed rule, CMS proposed a change to the current clinical laboratory date-of-service policies for molecular pathology tests and for Advanced Diagnostic Laboratory Tests.
The specificity of ICD-10 ushered in a stronger focus on clinical coding audits. From internal reviews to external coding audits, healthcare organizations nationwide are revisiting tried-and-true audit practices with ICD-10 coding quality in mind.
Improper payments can easily occur due to errors in billing, coding, or medical necessity. As such, it’s important to have a program in place to help you identify and prevent improper payments.
