Tag: Medicare claims

OIG reviewing OASIS fall reporting

The Department of Health and Human Services Office of Inspector General has announced a new review of the “accuracy of falls reporting in home health OASIS assessments,” according to a work plan update for May 2022. The OIG noted that Care Compare now includes the percentage of patients in home health care who fell and […]

CMS: Pay attention to telehealth billing rules

CMS is reminding providers to ensure that Medicare claims for telehealth are correctly billed. The agency issued broadly expanded telehealth services as part of its response to the COVID-19 public health emergency. However, a 2018 Office of Inspector General audit found that CMS paid practitioners for some telehealth claims that did not meet Medicare requirements […]

Early PDGM data reveal surprising findings about agency behavior

Data from a recent study of Medicare home health cost reports supports the case that the home health industry didn’t respond with the behavioral adjustments that CMS predicted prior to PDGM. And agencies have experienced increased challenges due to the public health emergency (PHE) that CMS should consider when finalizing the 2021 payment rule. The […]

CMS announces new, more targeted Medicare audit process

After reporting favorable results from a pilot program started in 2014 to reduce errors in the Medicare claims submission process, CMS announced last week that they will move forward with the new auditing strategy—which combines a review of a sample of claims with education—changing the process slightly by moving from a broad “Probe and Educate” […]

CMS orders post-pay audit of SNF PPS claims

The Supplemental Medical Review Contractor (SMRC) is charged with conducting nationwide medical review as directed by the Centers for Medicare & Medicaid Services (CMS). Topics and timeframes for these reviews are dictated by CMS and are chosen to address specific agency interests regarding coverage, coding, payment, and billing practices. On March 17, 2017, SMRC announced […]