Findings from an Office of Inspector General (OIG) audit show that Blue Cross Blue Shield (BCBS) of Michigan submitted claims with high-risk diagnosis codes that did not comply with federal requirements, resulting in at least $14.5 million in overpayments to Medicare Advantage (MA).
Q: Do we need to submit a formal request to CMS for any of the COVID-19-related waivers to apply? Do we need to keep records or documentation pertaining to which waivers we've used and the services they apply to?
Q: What are the encryption requirements when using Google Drive™, Dropbox®, or other information-storing applications? How do we ensure HIPAA compliance when using them?
Q: As of May 1, UnitedHealthcare, the largest health insurance company in the United States, will be switching from using Milliman Care Guidelines (MCG) to InterQual. How will this affect organizations, and what can they do to smooth the transition?
Gore Medical Management LLC, a healthcare provider based out of Griffin, Georgia, reported a breach last month that impacted 79,100 individuals, according to the Office for Civil Rights (OCR) breach report.
A new report from the Office of Inspector General (OIG) shows that Medicare billing for high-level inpatient stays increased over a six-year period, sparking concerns by the government about upcoding.
Q: When two conditions are both present on admission, both meet the definition to be the principal diagnosis, and are “equally treated,” my understanding is that the condition does not have to be "equally treated" in the sense of duration/frequency. Is this correct?
