OIG report suggests CERT data could identify ‘high-risk’ home health agencies

A report from the Department of Health & Human Services (HHS) Office of Inspector General (OIG) recommends using Comprehensive Error Rate Testing Data (CERT) to identify “high-risk” home health agencies to help reduce improper payments and agency error rates. CMS didn’t agree with the recommendation, however. Instead CMS points to CMS’ fraud prevention system, targeted […]

CMS issues guidance for handling insufficient documentation, ADRs

This post originally appeared on Revenue Cycle Advisor and has been republished with permission. CMS issued change request (CR) 10778 on June 15, with an effective date of July 17, to update Chapter 12 of the Medicare Program Integrity Manual. The proposed update includes details for handling non-responders and insufficient responses to additional documentation requests […]

MAC Palmetto GBA releases many claims that were ‘incorrectly suspended’

Brought to you by Home Health Line. Many home health agencies were taken aback in early June after receiving what appeared to be additional documentation requests (ADRs) from SafeGuard Services LLC, a Unified Program Integrity Contractor (UPIC). But it appears some claims were “incorrectly suspended,” according to a post on Medicare Administrative Contractor (MAC) Palmetto […]

OIG releases new report on contractor error rate

The Office of the Inspector General (OIG) released a report that focused on the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Error Rate Testing (CERT) program. Read on to learn more about what the report found.