Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Medical Billing Errors

New Medicare Fraud Audits to Ease Burden on Compliant Providers

August 21, 2017 - CMS recently updated its Medicare fraud and improper payment audit process to target providers and suppliers who continually demonstrate high medical billing error rates, according to the federal agency’s website. The new Targeted Probe and Educate method replaces the medical review strategy that included broad medical billing investigations and provider education. Starting in 2014,...


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Patient Financial Responsibility Not Owed Top Medical Debt Issue

by Jacqueline Belliveau

A recent report from the think tank Frontier Group and the US Public Interest Research Group (PIRG) Education Fund may spell trouble for providers attempting to collect overdue patient financial responsibility either internally or through a debt...

OIG: NJ Agency Falsely Claimed $95M in Medicaid Reimbursement

by Jacqueline Belliveau

New Jersey’s Department of Health and Human Services may have to repay the federal government almost $95 million after the Office of the Inspector General (OIG) recently found that the state agency received improper Medicaid reimbursement...

CMS Reduces Inpatient Medicare Improper Payment Rate by 58%

by Jacqueline Belliveau

In a recent official blog post, CMS touted that the Medicare improper payment rate for inpatient hospital claims fell by 58.3 percent between 2014 and 2016. While Medicare inpatient hospital claims accounted for $10.45 billion in improper payments...

OIG: NY Hospital Received $14.2M in Medicare Improper Payments

by Jacqueline Belliveau

A New York-based hospital overbilled Medicare by over $14.2 million between 2011 and 2012 because it did not have appropriate medical billing measures to prevent and identify improper payments, reported the Office of the Inspector General (OIG)....

4 Medical Billing Issues Affecting Healthcare Revenue Cycle

by Jacqueline Belliveau

Medical billing is the backbone of healthcare revenue cycle management, but many providers experience significant challenges with efficiently and accurately billing patients and payers for services they perform. The medical billing process can...

Improper Medical Billing for DMEPOS Costs Medicare Billions

by Catherine Sampson

Medicare continues to lose billions as a result of improper medical billing for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), according to the Council for Medicare Integrity. Specifically, the Medicare program had...

HHS Challenges Industry to Improve Medical Billing Process

by Catherine Sampson

It’s no secret that the current medical billing process is deeply flawed. To face this issue, the Department of Health and Human Services (HHS) recently announced the “A Bill You Can Understand" design and innovation challenge,...

21 States Have Overbilled the FFS Medicare Program

by Vera Gruessner

New research from the Centers for Medicare & Medicaid Services (CMS) shows that 21 states have above average rates of overbilling the Medicare program. The Supplementary Appendices for the Medicare Fee-for-Service (FFS) Improper Payment Report...

5 Ways Smaller Providers Maximize Revenue Cycle Management

by Jacqueline DiChiara

Revenue cycle management is about breaking through the cash flow ceiling and generating the greatest amount of net revenue possible. But issues of claims denials, coding compliance, where to intelligently cut cost corners, automation hiccups,...

Medical Billing Complexity Wastes $375 Billion Annually

by Ryan Mcaskill

A new study found that the red tape of medical billing is leading to billions of dollars in wasted resources. There are a number of factors that impact medical billing that are unavoidable. However, it is the waste created by the avoidable factors...

Jurisdiction 15 Received $548K in Medicare Overpayments

by Ryan Mcaskill

Billing errors related to cardiac medical device manufacturer’s credits led to $580,000 in overpayments during 2011. The Department of Health and Human Services Office of Inspector General (OIG) released the results of its audit of CGS Administrators....

OHSU Received $2.4M in Medicare Overpayments

by Ryan Mcaskill

A new study finds human error caused Oregon Health and Science University to receive overpayments between 2010 and 2012. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a Medicare compliance review...

Billing Errors Lead to $1.7 Million in Medicare Overpayments

by Ryan Mcaskill

Hackensack University Medical Center received overpayments in a sampling of 62 claims during an 18-month period. The Department of Health and Human Services Office of Inspector General (OIG), released its Medicare compliance review of Hackensack...

Diagnosis Code Confusion Leads to Medical Billing Errors

by Ryan Mcaskill

Several hospitals across the country miscoded Kwashiorkor, resulting in Medicare overpayments. For medical billing to be accurate, it is critical for practitioners to code every procedure and disease treated accurately. Failure to do this can...

Mission Hospital Billing Errors Result in Overbilling of $443K

by Ryan Mcaskill

The Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) released the results of a compliance review of Mission Hospital in Asheville, North Carolina. The audit was conducted for the calendar years of 2011 and...

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