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Audits MACs

Bass, Berry & Sims PLC

CMS Audits: Part 1 The ABCs of Medicare and Medicaid Claims Audits: Understanding the Audit Contractors

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Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should...more

King & Spalding

OIG Audit Finds That Providers Did Not Always Comply with Federal Requirements When Claiming Medicare Bad Debts

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This month, OIG published its findings relating to its audit on providers who sought reimbursement from Medicare for bad debts. OIG conducted the audit to confirm whether: (a) providers complied with Federal requirements...more

Arnall Golden Gregory LLP

The “Vacation” Is Over: CMS Resumes Hospice Targeted Probe and Educate Audits

On September 1, 2021, as hospice providers continue to grapple with the demands of the ongoing pandemic, the Centers for Medicare & Medicaid Services (CMS) ended its temporary suspension of the Targeted Probe and Educate...more

Baker Donelson

CMS Budget Justification Requests Increased Audit and Appeals Funding

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The Centers for Medicare & Medicaid Services' (CMS) FY 2022 Budget Justification request to Congress suggests an increased focus on Medicare claim reviews and an effort to decrease the number of claim denials overturned...more

Fox Rothschild LLP

Medicare Appeals And Audit Waivers Amid The COVID-19 Pandemic

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In the event of a national disaster or emergency under the Stafford Act or the National Emergencies Act and a Public Health Emergency Declaration by government officials, the Department of Health and Human Services (HHS)...more

Health Care Compliance Association (HCCA)

Observation Is Attracting Audit Attention; Hours Are a Risk, And Watch Out for the MOON

Report on Medicare Compliance 29, no. 5 (February 10, 2020) -  At least two Medicare administrative contractors (MACs) have set their sights on observation services, and there may be more to come. WPS is auditing...more

King & Spalding

OIG Report Finds CMS Made an Estimated $94 Million in Incorrect Medicare EHR Incentive Payments to Acute-Care Hospitals

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On December 12, 2019, OIG released a report finding that CMS made an estimated $94 million in incorrect Medicare incentive payments to acute-care hospitals for using electronic health records (EHRs) over an audit period from...more

King & Spalding

CMS Begins Audits of Worksheet S-10 for FY 2015 Cost Reports

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In the Inpatient Prospective Payment System (IPPS) rulemaking for fiscal year (FY) 2019, the Centers for Medicare and Medicare Services (CMS) announced that it would begin auditing the charity care and bad debt costs...more

Roetzel & Andress

CMS Expanding The "Targeted Probe And Educate" Audits Nationally This Fall

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The Centers for Medicare and Medicaid Services (“CMS”) announced recently that it will be expanding its medical claims review program to cover the entire country by the end of this year. The expanded program, titled “Targeted...more

Dorsey & Whitney LLP

CMS To Expand Use of TPE Audits Nationwide by End of 2017

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Perhaps lost amid the healthcare news coverage of competing proposals regarding “Medicare for All” and the repeal of Obamacare, the Centers for Medicare & Medicaid Services (“CMS”) last month announced the expansion of its...more

Baker Donelson

Targeted Probe and Educate – CMS Changes Its Approach to Auditing

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Medicare providers and suppliers will now be subject to Targeted Probe and Educate (TP&E) audits beginning this fall. These TP&E audits will focus on limited audits of individual providers and provider education. This new...more

Davis Wright Tremaine LLP

Emerging EHR Risks: When Documentation May Not Be Enough (or Too Much)

Today’s Electronic Health Record (EHR) technologies feature many tools that help providers practice more efficiently and allow them to spend more time caring for patients. However, the federal government recently has posted...more

Sheppard Mullin Richter & Hampton LLP

Enforcement of the Two-Midnight Rule Delayed Again

Last week President Obama signed into law a measure to extend Medicare physician pay rates for one year and to extend the enforcement delay of the “Two-Midnight” rule through March 2015. Medicare Recovery Audit Contractors...more

Baker Donelson

CMS Posts Guidance on Two-Midnight Rule and Related Audits

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On February 24, 2014, CMS posted a list of updates to its guidance on the new Two-Midnight Rule and the Probe and Educate Audits. Several of the more major updates are discussed below....more

Baker Donelson

A Calm Before the Storm: Updates on CMS Audit Activity

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In February 2014, CMS made two announcements that affect future Medicare audits. First, CMS instructed RACs to stop issuing post-payment additional documentation requests (ADRs) after February 21 and instructed MACs to stop...more

King & Spalding

CMS Announces Transition Process for RAC Contracts

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On February 18, 2014, CMS announced that it is in the procurement process for the next round of Recovery Audit Contractor (RAC) program contracts and that the transition to new contracts will include a pause in RAC audits in...more

Baker Donelson

CMS Issues Additional Guidance Related to 2-Midnight Rule

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Earlier this month, CMS posted three new documents related to the 2-midnight rule for inpatient admissions on its webpage for inpatient hospital reviews: new FAQs, as well as CMS directions for selecting hospital claims for...more

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