The improper payment rate for routine venipuncture lab tests was 16.3% in 2018, representing more than $20 million, and medical necessity errors accounted 98.9% of the improper payments, according to CMS.
Federal fraud watchdog agencies may be taking a closer look at Medicare Advantage in 2019, according to a recent report released by Bass, Barry & Sims, a Washington, D.C.-based law firm.
Q: How far in advance are we required to provide an Advance Beneficiary Notice of Noncoverage (ABN)? If multiple entities are involved in ordering and providing a noncovered service such as a lab test, does each entity need to issue a separate ABN?
The Office of Inspector General (OIG) will be taking a closer look at payments for inpatient claims subject to CMS’ post-acute transfer policy, according to a recent update to the OIG work plan.
The National Association of Healthcare Revenue Integrity is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida.
CMS ramped up risk-sharing for accountable care organizations (ACO) in a final rule published December 31, 2018. The final rule makes changes to the Medicare Shared Savings Program and will reduce the amount of time ACOs can stay in one-sided risk models.
Hospitals are allowed to publish a list of charges that contains UB-04 revenue codes when complying with 2019 IPPS final rule requirements requiring the publication of standard charges, the American Hospital Association (AHA) said in a regulatory advisory bulletin
A proposed rule that would expand the use of prior authorization and step therapy for Part D and Medicare Advantage beneficiaries has earned criticism from patient advocacy groups and praise from pharmacy groups.
