Medicare made $54.4 million in improper payments to acute care hospitals for post-acute transfers that did not comply with Medicare’s policies, according to a November 1 report from the Office of Inspector General (OIG).
CMS released the 2020 OPPS proposed rule July 29, proposing to refine previous policies related to price transparency and the 2-midnight rule, moving forward with year two of the site-neutral payment policy for clinic visits, while also asking for comments on how to potentially undo its policy that reduced payments for drugs purchased under the 340B drug discount program by nearly 30%.
Payer contract terms have far-reaching consequences, from the types of services covered and the documentation required to how appeals are negotiated. Learn how revenue integrity can collaborate with physician advisors to monitor and address problems with payer contracts.
Facilities need to know how to respond to documentation requests as part of any Medicare audit or review. Preparing a complete and proper reply makes all the difference in the outcome or results of those audits and reviews.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is key to revenue integrity success. Understanding its benefits and limits is important for any successful revenue integrity program.
