On Tuesday, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the results of a report that found improper coding in emergency department procedure codes led to $15 million in improper or potentially improper payments.
The report covered emergency department codes for services provided in 2021...National News
Not updated since 1999, the new guidance applies to all individuals and entities involved in the healthcare industry and serves as the Office of Inspector General's updated and centralized source of voluntary compliance program guidance for Medicare Advantage (MA). Entities and individuals can use the ICPG to help identify risks and...National News
CVS Health may be looking to split its retail and insurance branches following pressure from investors to improve performance. The company is also facing a hefty bill from an audit by the U.S. Department of Health and Human Services Office of Inspector General (OIG) that found it owes millions in overpayments.
CVS's profit margins at...
On Friday, the Centers for Medicare and Medicaid Services issued a proposed rule that would give hospice providers a 2.8% reimbursement increase and would institute a number of penalties for hospices that fail to meet reporting requirements. The rule signals a long-expected federal crackdown on hospice fraud, waste and...
Last Saturday marked the third anniversary of COVID-19 being declared a worldwide pandemic.
As the Arizona Republic points out in a retrospective, since that declaration, COVID-19 has killed more than 1.1 million Americans and 33,000 Arizonans.
There were 4,262 new cases of COVID-19 in Arizona this week with 56 new deaths related...
It was a big week for studies and reports on Medicare Advantage, both positive and negative for the industry as a whole.
The Better Medicare Alliance recruited ATI Advisory to conduct a study on how much Medicare Advantage beneficiaries save by comparison to beneficiaries with traditional Medicare. It found that MA enrollees save a...
Medicare Advantage is under pressure to demonstrate its cost-savings for the Medicare program following a report for the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) that suggests Medicare Advantage (MA) plans "may have inappropriately" leveraged chart reviews and health risk assessments to...
The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) published a study on September 23 that found 20 Medicare Advantage companies generated a disproportionate share of federal overpayments by manipulating chart reviews and health risk assessments (HRA) to drive up reimbursement.
Total...
According to a new study from the Centers for Disease Control and Prevention, nursing aides are the most likely to interact with long-term care residents but are the industry's least likely workers to be vaccinated against COVID-19.
Concerning Statistics
CDC researchers looked at data from 300 U.S. facilities and found that...National News
On Monday, the Supreme Court declined to take up a lawsuit over the Trump administration Center for Medicare & Medicaid Services's (CMS) Medicare Part B pay cuts for outpatient clinic visits at off-campus hospital facilities. In February, the American Hospital Association (AHA), America's Essential Hospitals and the Association of...News
The Department of Health and Human Services Office of Inspector General found that the Centers for Medicare & Medicaid Services (CMS) lacked the authority to ensure that hospitals had appropriate emerging infectious disease preparedness plans in place during the COVID-19 pandemic.
The OIG conducted this audit to asses how CMS is...National News
A Humana Inc. Medicare Advantage plan in Florida overcharged Medicare by $200 million in 2015 alone, according to the Department of Health and Human Services (HHS) Office of Inspector General (OIG). If the OIG's recommendation to repay is finalized, it would become the largest audit penalty ever imposed on a Medicare Advantage...CMS Rules
This week, the Supreme Court suspended hearings on Medicaid work requirements as other Trump era Medicaid policies come under fire. Plus, states aren't quite meeting reporting requirements and more reporting adjustments could be on the way.
The U.S. Supreme Court suspended its review of the Medicaid work requirements and removed the...Government
The U.S. Department of Heath and Human Services Office of Inspector General conducted a review of 320 hospitals nationwide. The review is designed to provide a national perspective from front-line hospital administrators on how responding to the COVID-19 pandemic has affected their capacity to care for patients, staff and communities....Arizona News
There were 445 new COVID-19 cases reported in the state of Arizona on Wednesday, and 12 new deaths reported. These numbers will be retroactively reassigned to the dates in which the deaths took place. With 22,777 new tests reported today, the total percent positive has now fallen to 11.1%. Adult intensive care unit beds in use by...National News
Last week Kaufman Hall released a report commissioned by the American Hospital Association predicting hospitals will continue to see depressed revenues this year the same month the Office of Inspector General found that before the pandemic hospitals were increasingly billing for inpatient stays at the highest severity level, which is the...Arizona News
The Arizona Health Care Cost Containment System (AHCCCS) released its 2020 Year in Review this week, enumerating the efforts by the agency to innovate improvements in service delivery and its overall response to the COVID-19 pandemic.
AHCCCS announced that over 60% of the agency’s staff is now run through a virtual work environment,...National News
The Centers for Medicare and Medicaid Services granted itself more time to finalize a rule that would revise Stark Law, which prohibits self-referrals by physicians. In a note in the Federal Register, the agency said the rule would not come before the August 31, 2020 deadline and extended it through August 2021.
In a statement to...Arizona News
The Centers for Medicare and Medicaid Services fined nursing homes across the country a total of $15 million during the COVID-19 pandemic for noncompliance with reporting data to the agency or not following infection control guidelines.
The agency made the announcement on August 14, and in a press release stated that the penalties...Arizona News
Nursing homes this week experienced a surge of miscommunication during a spike in newly reported cases of COVID-19. Nationally and locally, organizations are trying to grapple with an influx of new information and the ramifications of an old and neglected system.
In the most recent weekly update of CMS data, more nursing homes...
