![]() Substance use disorders also remained in the top five in the Midwest and Northeast, as had been the case in April. The latest data from Fair Health’s monthly telehealth regional tracker indicated substance use disorders joined the top five telehealth diagnoses nationally for the first time in May, in fifth place. Finally, the OIG suggested that CMS implement claim system edits to prevent and detect overpayments for noncomplex and complex CCM services.įair Health: The top 5 national telehealth diagnoses in May The OIG also recommended that CMS notify appropriate providers to exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation. CMS has agreed with the OIG’s recommendation that the agency direct the Medicare contractors to recover the $1.9 million for claims that are within the reopening period and instruct providers to refund up to $540,680, which beneficiaries were required to pay. The OIG said the errors occurred because CMS did not have claim system edits to prevent and detect overpayments. ![]() $52,086 in overpayments identified in 863 claims for incremental complex CCM services that were billed along with complex CCM services.$438,262 in overpayments identified in 10,882 claims for instances in which the same provider billed for both noncomplex or complex CCM services and overlapping care management services rendered to the same beneficiaries for the same service periods.$1.4 million in overpayments associated with 38,447 claims for instances in which providers billed noncomplex or complex CCM services more than once for the same beneficiary for the same service period.For these claims, beneficiaries’ cost sharing totaled $540,680. The OIG found that Medicare made $1.9 million in overpayments associated with 50,192 claims for noncomplex and complex CCM services that didn’t comply with federal requirements. Medicare paid $356 million for those services. The audit covered more than 7.8 million claims submitted by physicians and over 240,000 claims submitted by hospitals for noncomplex and complex CCM services provided in calendar years 20. OIG: Medicare continues to make overpayments for chronic care management servicesĪ new OIG report has found that overpayments for chronic care management (CCM) services has cost the program and its beneficiaries millions of dollars. The CVS disclosure was made in the wake of the Justice Department’s announcement that it had joined lawsuits filed by 10 whistleblowers alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its MA plan enrollees in order to receive higher reimbursements. ![]() In the filing, CVS said it expects CMS and the OIG to continue the audits and that CMS may require Aetna to refund risk-adjusted premiums if they aren’t supported by medical record data. The OIG reportedly is planning to release similar audits within the next two years. health plan for seniors in Florida by nearly $200 million in 2015 by overstating how sick some patients were. The Centers for Medicare & Medicaid Services (CMS) will reimburse an MA plan at a higher rate for caring for sicker patients or those with a more severe diagnosis and higher risk score.Įarlier this year an OIG audit found that CMS overpaid a Humana Inc. The OIG has been conducting a series of audits to make sure MA plans aren’t submitting inaccurate diagnosis codes for risk-adjustment payments. Department of Health and Human Services’ OIG is auditing MA operations. RISE reviews the latest headlines, including the Office of Inspector General (OIG) reports, trending telehealth diagnoses, and the introduction of a new bill to improve the oversight of nursing homes.ĬVS discloses OIG auditing Aetna’s MA programĬVS Health, the parent company of Aetna’s Medicare Advantage (MA) business, disclosed in a recent federal filing that the U.S.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |