Download or read book Medicare Recovery Audit Contractors and Cms s Actions to Address Improper Payments Referrals of Potential Fraud and Performance written by CreateSpace Independent Publishing Platform and published by Createspace Independent Publishing Platform. This book was released on 2018-07-05 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare recovery audit contractors and CMS's actions to address improper payments, referrals of potential fraud, and performance.
Download or read book Medicare Recovery Audit Contractors and CMS s Actions to Address Improper Payments Referrals of Potential Fraud and Performance written by United States. Department of Health and Human Services. Office of Inspector General and published by . This book was released on 2013 with total page 31 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Recovery Audit Contracting written by Kathleen M. King and published by DIANE Publishing. This book was released on 2010-08 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Centers for Medicare & Medicaid Services (CMS) conducted a three-year project to demonstrate the use of recovery audit contractors (RAC) in identifying Medicare improper payments and recouping overpayments. This report examined issues that arose during the demonstration project and CMS¿s efforts to address them in the national RAC program. It examines the extent to which CMS: (1) developed a process and took corrective actions to address vulnerabilities identified by the RACs that led to improper payments; (2) resolved coordination issues between the RACs and the Medicare claims admin. contractors; and (3) established methods to oversee RAC claim review accuracy and provider service during the national program. Charts and tables.
Download or read book Medicare Recovery Audit Contracting written by United States. Government Accountability Office and published by . This book was released on 2010 with total page 47 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Centers for Medicare & Medicaid Services (CMS) conducted a mandated 3-year project from March 2005 through March 2008 to demonstrate the use of recovery audit contractors (RAC) in identifying Medicare improper payments and recouping overpayments. CMS implemented a mandated national RAC program, which began in March 2009. GAO was asked to examine specific issues that arose during the demonstration project and CMS's efforts to address them in the national RAC program. This report examines the extent to which CMS (1) developed a process and took corrective actions to address vulnerabilities identified by the RACs that led to improper payments, (2) resolved coordination issues between the RACs and the Medicare claims administration contractors, and (3) established methods to oversee RAC claim review accuracy and provider service during the national program. GAO reviewed CMS documents and interviewed officials from CMS and contractors and provider groups affected by the demonstration project.
Download or read book Medicare Fraud Waste and Abuse Challenges and Strategies for Preventing Improper Payments written by Kathleen M. King and published by DIANE Publishing. This book was released on 2010-10 with total page 15 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare¿s size and complexity make it vulnerable to fraud, waste, and abuse. Fraud represents intentional acts of deception with knowledge that the action or representation could result in an inappropriate gain, while abuse represents actions inconsistent with acceptable bus. or med. practices. Waste, which includes inaccurate payments for services, also occurs in the Medicare program. In 2009, the Centers for Medicare and Medicaid Services (CMS) estimated billions of dollars in improper payments in the Medicare program. This statement focuses on challenges facing CMS and selected key strategies that are particularly important to helping prevent fraud, waste, and abuse, and ultimately to reducing improper payments. Illustrations.
Download or read book The Medicare Recovery Audit Contractor Program written by Duane C. Abbey and published by CRC Press. This book was released on 2017-11-15 with total page 139 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment
Download or read book Medicare improper payments challenges for measuring potential fraud and abuse remain despite planned enhancements written by and published by DIANE Publishing. This book was released on with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Mismanagement Oversight of the Federal Government Effort to Recapture Misspent Funds Serial No 113 136 May 20 2014 113 2 Hrg written by and published by . This book was released on 2014 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Improper Payments written by Kay Daly and published by DIANE Publishing. This book was released on 2001-04 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt: Reviews the Health Care Fin Admin's. (HCFA) efforts to enhance the measurement of improper payments in the Medicare fee-for-service program. Identifies structural problems that exist in the Medicare claims processing system which contribute to vulnerabilities resulting in erroneous Medicare payments. Focuses on: what HCFA proposals have been designed or initiated to measure Medicare improper payments; & the status of these proposals & initiatives & how they will enhance HCFA's ability to comprehensively measure improper Medicare payments & the frequency of kickbacks, false claims, & other inappropriate provider practices. Tables.
Download or read book Medicare Mismanagement written by United States. Congress. House. Committee on Oversight and Government Reform. Subcommittee on Energy Policy, Health Care, and Entitlements and published by . This book was released on 2014 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Fraud Progress Made But More Action Needed to Address Medicare Fraud Waste and Abuse written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-27 with total page 26 pages. Available in PDF, EPUB and Kindle. Book excerpt: " GAO has designated Medicare as a high-risk program, in part because the program's size and complexity make it vulnerable to fraud, waste, and abuse. In 2013, Medicare financed health care services for approximately 51 million individuals at a cost of about $604 billion. The deceptive nature of fraud makes its extent in the Medicare program difficult to measure in a reliable way, but it is clear that fraud contributes to Medicare's fiscal problems. More broadly, in fiscal year 2013, CMS estimated that improper payments-some of which may be fraudulent-were almost $50 billion. This statement focuses on the progress made and important steps to be taken by CMS and its program integrity contractors to reduce fraud in Medicare. These contractors perform functions such as screening and enrolling providers, detecting and investigating potential fraud, and identifying improper payments and vulnerabilities that could lead to payment errors. This statement is based on relevant GAO products and recommendations issued from 2004 through 2014 using a variety of methodologies. In April 2014, GAO also received updated information from CMS on its actions related to the laws, regulations, and guidance discussed in this statement. Additionally, GAO updated information by examining public documents and relevant policies"
Download or read book Health Care Finance and the Mechanics of Insurance and Reimbursement written by Michael K. Harrington and published by Jones & Bartlett Learning. This book was released on 2019-10-01 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Care Finance and the Mechanics of Insurance and Reimbursement stands apart from other texts on health care finance or health insurance, in that it combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle in detail, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Thoroughly updated for its second edition, this text reflects changes to the Affordable Care Act, Managed Care Organizations, new coding initiatives, new components of the revenue cycle (from reimbursement to compliance), updates to regulations surrounding health care fraud and abuse, changes to the Recovery Audit Contractors (RAC) program, and more.
Download or read book Preventing and Recovering Medicare Payment Errors written by United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security and published by . This book was released on 2011 with total page 172 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Advantage Fundamental Improvements Needed in CMS s Effort to Recover Substantial Amounts of Improper Payments Report to the Chairman Committee on Ways and Means House of Representatives written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-25 with total page 33 pages. Available in PDF, EPUB and Kindle. Book excerpt: " In 2014, Medicare paid about $160 billion to MA organizations to provide health care services for approximately 16 million beneficiaries. CMS, which administers Medicare, estimates that about 9.5 percent of its payments to MA organizations were improper, according to the most recent data-primarily stemming from unsupported diagnoses submitted by MA organizations. CMS currently uses RADV audits to recover improper payments in the MA program. GAO was asked to review the extent to which CMS is addressing improper payments in the MA program. This report examines the extent to which (1) CMS's contract selection methodology for RADV audits facilitates the recovery of improper payments, (2) CMS has completed RADV audits and appeals in a timely manner, and (3) CMS has made progress toward incorporating RACs into the MA program to identify and assist with improper payment recovery. In addition to reviewing research literature and agency documents, GAO analyzed data from ongoing RADV audits of 2007 and 2011 payments-CMS's two initial contract-level RADV audits. GAO also interviewed CMS officials. "
Download or read book Overcharged written by Charles Silver and published by Cato Institute. This book was released on 2018-07-03 with total page 582 pages. Available in PDF, EPUB and Kindle. Book excerpt: Why is America's health care system so expensive? Why do hospitalized patients receive bills laden with inflated charges that com out of the blue from out-of-network providers or demands for services that weren't delivered? Why do we pay $600 for EpiPens that contain a dollar's worth of medicine? Why is more than $1 trillion - one out of every three dollars that passes through the system - lost to fraud, wasted on services that don't help patients, or otherwise misspent? Overcharged answers these questions. It shows that America's health care system, which replaces consumer choice with government control and third-party payment, is effectively designed to make health care as expensive as possible. Prices will fall, quality will improve, and medicine will become more patient-friendly only when consumers take charge and exert pressure from below. For this to happen, consumers must control the money. As Overcharged explains, when health care providers are subjected to the same competitive forces that shape other industries, they will either deliver better services more cheaply or risk being replaced by someone who will.
Download or read book Medicare Recovery Audit Contracting written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2018-05-12 with total page 26 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare Recovery Audit Contracting: Lessons Learned to Address Improper Payments and Improve Contractor Coordination and Oversight
Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
