Simplify & Control Healthcare Costs
Did you know that the Center for Medicare & Medicaid Services (CMS) enlists the help of outside Recovery Audit Contractors (RAC’s) to identify and correct improper payments that have occurred? For FY2013, this resulted in the correction of over 1.5 million underpayments and overpayments, and returned in excess of $3.0 billion to the Medicare Trust Read More
Did you know that Medicare’s improper payment rate is calculated annually via the Comprehensive Error Rate Testing (CERT) program? Each year, CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules. For the twelve months ending June 30, 2013, the overall error Read More
Did you know that certain areas of the country are a “hotbed” of fraudulent medical billing, including such places as Miami, New York City, Detroit, Houston, Los Angeles, Tampa, and Baton Rouge? Organized crime in these regions systematically target & exploit control weaknesses in healthcare reimbursement systems, particularly Medicare.Read More
Did you know that the Center for Medicare & Medicaid Services (CMS) released data in April showing the summary of payments made by Medicare to 880,000 physicians nationwide? This data has been used to identify providers with patterns of suspect or even potentially fraudulent billing. One ophthalmologist from West Palm Beach, FL collected nearly $21 Read More
Did you know that according to the Health & Human Services Office of Inspector General, Medicare overpaid physicians $6.7 billion for evaluation and management services in 2010? The overpayments were caused primarily by incorrect medical coding and inadequate documentation. This represented more than one-fifth of overall payments issued for E/M services that year.Read More
Did you know that Medicare’s operating rules allow it to pay for prescription drugs up to 32 days after a patient’s death – not a best practice? About 80% of these prescriptions were filled at neighborhood pharmacies, reflecting criminals acquiring the drugs to presumably sell on the black market at a hefty profit. High-priced drugs Read More
Did you know that certain prescription drugs have increased in cost at rates up to nearly 850% since 2007 versus an increase in the Consumer Price Index (CPI) of 12% during that period? Examples include Avonex (+147%), Gleevec (+158%), Viagra (+159%), EpiPen (+222%), Humulin R U-500 (+354%) and Xyrem (+841%). There are 15 cancer drugs Read More
Did you know that Medicare compares each doctors’ proportion of various types of office visits (new patient encounter, established patient, etc.) to determine if they conform to the national profile for all providers? If they do not conform to the typical percentages, the medical providers could be at higher risk for being audited and sanctioned Read More
Did you know that the National Correct Coding Initiative (NCCI) is intended to promote national correct coding methodologies and to minimize improper coding leading to inappropriate payment? These coding policies were developed jointly by CMS and the American Medical Association’s, and are updated annually to ensure the latest “best practices” are reflected. While originally developed Read More
Did you know that hospital “readmissions” is considered a costly event in terms of both financial impact and negative health outcomes for affected patients? While some readmissions are “planned” as part of a care treatment, those that are not “planned” are to be coded on the medical record to enable tracking of the event for Read More
