New Requirements for Hospital Price Transparency in 2024
The 2024 OPPS Final Rule was published last week and contained significant updates and changes to the hospital price transparency rules, many of which are effective January 1, 2024. Although there is...
View ArticleOIG Semiannual Report to Congress
The OIG has issued their Semiannual Report to Congress for the period April 1, 2023 through September 30, 2023. The report highlights $3.44 billion in expected investigative and audit recoveries...
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2023 Medicare Improper Payments Data
The 2023 Medicare Fee-For-Service Improper Payments Report was just released. The report identified an estimated $31.23 billion in improper payments with a payment error rate of 7.38%. The report...
View ArticleOIG Semiannual Report to Congress
The OIG has issued their Semiannual Report to Congress for the period October 1, 2023 through March 31, 2024. The report highlights over $2.76 billion in expected investigative and audit recoveries...
View ArticleOIG Issues Recommendations for Short Stay Admissions
The OIG conducted an audit to evaluate the effectiveness of Medicare program safeguards to ensure appropriate reimbursement of short stay inpatient admissions. In general, inpatient admissions which...
View ArticleCMS Releases the 2025 OPPS Proposed Rule
CMS released the 2025 OPPS and ASC Proposed Rule this morning. The 984 page document contains a number of important proposals including: 2.6% payment increase for eligible hospitals New conditions of...
View ArticleCMS Releases the 2025 Proposed Medicare Physician Fee Schedule
CMS has released the 2025 Proposed Medicare Physician Fee Schedule. The proposal contains many significant coding and coverage provisions including: 2.93% payment decrease Permanent coverage of audio...
View Article2025 ICD-10-CM Changes
CMS recently posted the 2025 ICD-10-CM files that contain code additions, revisions and deletions to the code set. The implementation date of October 1, 2024 is fast approaching. The 2025 ICD-10-CM...
View ArticleOIG August Work Plan
The OIG issued their August Work Plan. The update includes plans to evaluate whether Medicare paid physicians for hyaluronic acid knee injections in accordance with Medicare requirements. The FDA and...
View ArticlePhysician Visit Volumes Continue to be an Audit Risk
As compliance professionals, the concept of an “unlikely” physician day is not a new risk area. Conducting data analysis of time-based services to identify instances where billings frequently...
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