Auditing and monitoring

This week’s updates include the October 2015 update of the ASC payment system; postpayment review requirements; and more! Click here to read all of this week’s updates.

Adding modifiers to CPT® codes can bypass NCCI edits for Medicare payments, but they're often misapplied.

This week’s note is about the changes to the 2-Midnight Rule in the 2016 OPPS proposed rule. In the 2016 OPPS Proposed Rule, CMS announced that October 1, 2015 they will be transitioning the medical review of inpatient admissions from Medicare Administrative Contractors (MAC) to Quality Improvement Organizations (QIO). This policy will limit the future review of inpatient admissions by the Recovery Auditors and may be related to CMS’ withdrawal of the Request for Quotes for new Recovery Auditors announced July 10.

Being audited is rarely fun. After all, you're probably going to lose money, face a fine, or both. More and more entities are auditing healthcare claims-Recovery Auditors, Medicare Integrity Contractors, MACs, FIs, commercial payers, and on and on.

CMS has instructed MACs to reprocess claims and providers to reimburse beneficiaries due to a miscalculated copayment for stereotactic radiosurgery, according to the October update to the OPPS and Integrated Outpatient Code Editor (I/OCE).

This week’s note is about the OIG’s 2015 Work Plan mid-year update. Click the link above for more information and an in-depth analysis. 

The majority of Recovery Auditor (RA) takebacks in the past year involved hospitals (88%) and physicians (5%), which isn’t surprising because of the volume of services they provide, says De

We are four months into the new fiscal year and the Office of Inspector General (OIG) has finally released its highly anticipated Work Plan. Click the link above for more information and an in-depth analysis.

When Shallie J. Bryant, CHC, CHPC, went to work at CaroMont Health in North Carolina more than two years ago, her biggest challenge was creating a culture of patient privacy.

The reason R. Brett Short, chief compliance officer at UK HealthCare at the University of Kentucky, talks about his organization’s OCR audit is to share the lessons he learned.

UK HealthCare’s Albert B. Chandler Hospital was one of 20 covered entities to undergo an initial test audit by the OCR in 2012.