The 2024 Medicare Fee-For-Service Improper Payments Report was just released. The report identified an estimated $31.70 billion in improper payments with a payment error rate of 7.66%, up from last year. The report outlines findings related to services most frequently billed and paid in error and outlines the reasons for
The Office of Inspector General (OIG) issued their November Work Plan. The update includes plans to evaluate incident to services to determine whether they complied with Medicare requirements. Improper payments of incident to services continues to be the focus of numerous audits, overpayment and False Claims Act settlements. Incident to
The Office of Inspector General (OIG) recently issued a report regarding compliance with the CMS Hospital Price Transparency Rule (HPT rule). Compliance with the HPT requirements was added to the OIG’s Work Plan in 2022 due in part, to concerns raised by congressional and consumer advocacy groups as well as
CMS released the 2025 OPPS and ASC Final Rule last Friday. The 1,734 page document contains a number of important changes including: 2.9% payment increase for eligible hospitals New conditions of participation (CoPs) for obstetrical services Revisions of CoPs related to emergency readiness and discharge planning/transfer protocols Updates to the
CMS has released the 2025 Medicare Physician Fee Schedule Final Rule. The 3,088 page rule contains many significant coding and coverage provisions including: 2.83% payment decrease. The House has introduced a bill that would provide a 4.7% payment update which would eliminate the 2.83% decrease, if passed. Permanent coverage of
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 exceeded a set number of hours per day has been commonplace in most organizations for many years. However, with the change in
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