The Latest News
Medical Coding Billing & Compliance News
compiled by Team eduTrax
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Written by Team eduTrax
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Monday, 05 April 2010 00:00 |
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Council Denies CMS Appeal
The Medicare Appeals Council (Council) disagreed with the Centers for Medicare and Medicaid Services (CMS) when asked by CMS to review and overturn a September 2009 decision by an Administrative Law Judge (ALJ). The case concerns an ALJ decision that agreed with a Demonstration Project RAC to deny Medicare coverage for inpatient hospitalization services as billed in November 2004 by O'Connor Hospital of San Jose, California, based on a lack of medical necessity, but went on to find that the "observation and underlying care" was nevertheless warranted, and therefore such services that were provided (normally only billed under Part B) must be reimbursed by CMS, thereby offsetting some of the overpayment resulting from the inpatient denial (originally billed under Part A).
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Last Updated on Monday, 05 April 2010 21:23 |
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Written by Team eduTrax
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Wednesday, 24 March 2010 00:00 |
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RACs identify fraud cases and improper payments
The Centers for Medicare & Medicaid Services (CMS) conducted a demonstration project from 2005 to 2008 to detect and correct past improper payments in the Medicare fee-for-service program, and to provide information to CMS and the Medicare claims processing contractors that could help protect Medicare trust funds by preventing future improper payments. The Office of Inspector General (OIG) recently published a report on how CMS and the recovery audit contractors (RACs) handled fraud cases found during the demonstration project.
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Last Updated on Wednesday, 24 March 2010 18:16 |
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Written by Team eduTrax
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Wednesday, 24 March 2010 00:00 |
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Realized Nearly $4 Billion in Settlements, Fines, Penalties & Restitution
In fiscal year (FY) 2009, OIG’s enforcement efforts resulted in over 670 criminal actions, of which 515 involved heath care fraud; over 362 civil actions (355 involved health care fraud); and realized nearly $4 billion in settlements and court-ordered fines, penalties, and restitution, approximately 75 percent of which involved health care fraud, according to testimony by Timothy Menke, Deputy Inspector General for Investigations at the U.S. Department of Health & Human Services’ (HHS) Office of Inspector General (OIG), before the Subcommittee on Crime, Terrorism, and Homeland Security of the House Committee on the Judiciary on law enforcement activities to combat Medicare and Medicaid fraud, on March 4, 2010.
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Last Updated on Wednesday, 24 March 2010 18:47 |
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Written by Team eduTrax
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Tuesday, 09 March 2010 00:00 |
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Expect More Programs Like Recovery Audit Contractors
President Obama signed a presidential memorandum directing all federal departments and agencies to “expand and intensify their use of payment recapture audits under their current authority,” on March 10. No additional legislation is needed, therefore, for the agencies to enact programs similar to CMS's Recovery Audit Contractors program. The President also announced his support for the Improper Payments Elimination and Recovery Act, new bipartisan legislation being proposed to expand the ability of government agencies to fund future audits with recaptured payments.
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Last Updated on Monday, 15 March 2010 19:00 |
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