A Humana health plan in Florida overcharged Medicare by nearly $200 million in 2015 by incorrectly billing for high severity hierarchical condition categories (HCC) that were not supported, according to...Read More »
I was wondering if anyone had experience with denials from commercial payers that goes beyond the third level of appeals. We are getting response letters that state “completion of a level 3 dispute exhausts internal administrative rights.” What are other hospital systems doing with this response...Read More »
Sunrise Hospital & Medical Center in Winchester, Nevada, submitted Medicare claims for rehabilitative services that did not comply with Medicare billing requirements,...Read More »
Findings from an Office of Inspector General (OIG) audit show that Blue Cross Blue Shield (BCBS) of Michigan submitted claims with high-risk ICD-10-CM codes that did not comply with federal requirements, resulting in at least $14...Read More »
A report from the Office of Inspector General (OIG) shows that Medicare billing for high-level inpatient stays increased over a six-year period, sparking concerns by the government about...Read More »
Between mid-2017 and pre-pandemic 2019, 774 hospitals have been penalized by the federal government for having high rates of patients with possibly avoidable medical complications, according to a hospital penalty “look-up” system by...Read More »
According to an Office of Inspector General (OIG) audit, CMS did not use Comprehensive Error Rate Testing (CERT) data to identify waste or fraud. The audit states that previous OIG reports “recommend using CERT data to identify...Read More »
