CMS announced that it achieved improper payment rate reductions in 2018 in Medicare Fee-For-Service (FFS), Medicare Part C, Medicare Part D, Medicaid, and Children’s Health Insurance Program. Notably, the fiscal year (FY) Medicare FFS improper payment rate is at 8%, which is the lowest it has been since 2010.
Novitas Solutions, Inc. plans to pursue $7.2 million in intensity-modulated radiation therapy (IMRT) overpayments to hospitals in its jurisdiction, according to an Office of Inspector General report.
In the 2019 OPPS final rule, released November 2, CMS implemented several site-neutral payment policies, though the agency did delay or shelve other proposals due to stakeholder feedback.
Although most eligible clinicians who participated in the first reporting year of the Merit-based Incentive Payment System received a positive payment adjustment, even the highest performing clinicians saw only a modest bonus.
Remittance processing and appeals are integral parts of the revenue cycle. When facilities submit a claim to Medicare, the hope is that the claim will be paid in full and in a timely manner, but that does not always happen.
Take a look at the appeal process from the perspective of a hospital that submitted a redetermination request after a claim for cataract surgery was reopened.
