From the College | Issue: November 2019 |
In February 2016, the Centers for Medicare & Medicaid Services (CMS) published the final rule on Medicare Reporting and Returning of Self-Identified Overpayments. This final rule from CMS has now established official policy for timely reporting and returning of Medicare overpayments received by healthcare providers, with a goal to provide clear requirements for reporting and…
What you need to know about the Recovery Audit Contractor program
Audit activity among Medicare and most third-party payers has increased in response to pressure to reduce healthcare costs. The return of billions of dollars to Medicare, Medicaid and third-party programs through these medical audit reviews has also increased. For example, the Government Accountability Office (GAO) 2014 Annual Report estimated that the Centers for Medicare &…
For a provider of healthcare services, payer audits are always a possibility. Both government and private payers consistently monitor providers to prevent fraud, overpayment, and improper billing or coding procedures. Audits can be nerve-racking and intimidating, even if a provider is billing correctly. Improper billing can lead to civil and criminal sanctions. To alleviate some…