OIG report
Medicare Providers Did Not Always Comply With Federal Requirements When Billing for Advance Care Planning
Medicare providers that billed for advanced care planning (ACP) services in an office setting did not always comply with Federal requirements, according to a new report from the Office of Inspector General (OIG). Specifically, the OIG investigation found that of the 691 ACP services associated with their sample, Medicare providers complied with Federal requirements for […]
Read MoreOIG: Home Health Responded to COVID Creatively, but Challenges Persist
Key issue of telehealth remains Home health agencies (HHAs) developed strategies to respond to challenges during the COVID-19 pandemic, including providing new incentives to maintain staff and seeking alternative sources of personal protective equipment, finds a new report from the Office of Inspector General (OIG). The report also concluded that HHAs were helped by regulatory flexibilities and expanded telehealth usage, and recommended […]
Read MoreOIG Finds Inappropriate Service Denials by MAOs
An Office of Inspector General (OIG) report determined that Medicare Advantage Organizations (MAOs) sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. In the report, Some Medicare Advantage Organization Denials […]
Read MoreOIG Reports on Home Health Agency Infection Control Audit
An audit of eight home health agencies (HHAs) by the Office of the Inspector General (OIG) found that most had infection control policies and procedures that met the stndards set by the Centers for Medicare & Medicaid Services (CMS) and followed CMS COVID-19 guidance to safeguard Medicare beneficiaries, caregivers, and staff during the coronavirus pandemic, according […]
Read MoreOIG: Poor Oversight Led Medicare to Overpay for Hospital Inpatient Claims with Post-Acute-Care Transfers to Home Health
A new report from the Office of Inspector General (OIG) has found that Medicare improperly paid most inpatient claims to the transfer policy when beneficiaries resumed homoe health services within three days of of discharge but the hospitals failed to code the inpatient claim properly and recommends the Centers for Medicare & Medicaid Services (CMS) […]
Read MoreMedicare Contractors Were Not Consistent In How They Reviewed Extrapolated Overpayments
The Office of Inspector General (OIG) of the Department of Health and Human Services conducted an audit to determine whether the Centers for Medicare & Medicaid Services (CMS) ensured that MACs and QICs reviewed appealed extrapolated overpayments consistently and in a manner that conforms with existing CMS requirements. The OIG concluded that the MACs and […]
Read MoreOIG: CMS Could Save Money Reviewing Home Health Claims With Visits Slightly Above LUPA
The Centers for Medicare & Medicaid Services (CMS) could have saved $192 million by targeting home health claims for review with visits slightly above the threshold that triggers a higher Medicare payment, according to a new report from the Office of Inspector General (OIG) of the Department of Health & Human Services. Home health agencies […]
Read MoreNAHC Issues Recommendations in Response to OIG Reports on Hospice Survey Performance and Related Concerns
NAHC address OIG concerns, recommend improvements In July the Department of Health & Human Services Office of the Inspector General (OIG) issued two reports representing in-depth study of findings from Medicare hospice recertification and complaint surveys. One report, Hospice Deficiencies Pose Risks to Medicare Beneficiaries, provides broad findings on frequencies of deficiencies and recommends greater public […]
Read MoreOIG Report Recommends CMS Use CERT Data to Identify High Risk Home Health Agencies
CMS Remains Opposed to Using CERT Data to Identify Improper Payments, Prefers TPE & RCD The Health and Human Services (HHS) Office of the Inspector General (OIG) recently released a report pertaining to home health agencies (HHA), The Centers for Medicare & Medicaid Services Could Use Comprehensive Error Rate Testing Data To Identify High-Risk Home […]
Read MoreOIG Finds Medicare Part D Still Spending Millions for Hospice Drugs
Over recent years the Department of Health & Human Services Office of the Inspector General (OIG) and others have conducted analyses of spending outside of hospice while patients are on service and determined that Medicare may be paying separately for care (including prescription drugs under Part D) that should be the responsibility of the hospice. […]
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