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Non-emergent ambulance transports are in the top 20 Part B services with improper payments, CMS said.
CMS has just released a proposed rule that would require Medicare prior authorization for certain Medicare Durable Medical Equipment items that the agency characterizes as "frequently subject to unnecessary utilization." The decisions would not be subject to appeal.
The Recovery Audit Contractor, or RAC, program is on vacation. CMS has slowed down audit activity in advance of new contracts. Still, this is no time for hospitals to get complacent about their audit management programs.
A new survey conducted by the Health Care Compliance Association (HCCA) shows that non-profit providers undergo a higher percentage of government audits than their for-profit peers.
Inpatient acute care hospital billing staff need to make sure medical documentation submitted demonstrates evidence of the clinical need for patients to be admitted and that it fully and accurately identifies any subsequent care provided during that stay.
In order to remain in compliance with Medicare rules, and avoid denials by recovery audit contractors (RACs) and others, hospitals must reduce outpatient procedures performed during inpatient stays.
A recent OIG report examined $4.7 million in improper FY 2009 Medicare payments identified by CMS's Comprehensive Error Rate Testing contractor.
Interest continues to run high on the recently updated signature guidelines issued by the Centers for Medicare & Medicaid Services. One of the new sections in Transmittal 327, issued March 16, relates to additional documentation requests (ADRs) and signature requirements.
Two recent publications issued by CMS clearly indicate that the organization is tightening its requirements for the documentation required to support medical necessity and mandated signatures on prescriptions and orders for services.
Medically unnecessary services topped the list of claim errors in the latest comprehensive error rate testing (CERT) report compiled in November 2009 and released last month by the Centers for Medicare & Medicaid Services.
