by Wyn Staheli, Director of Research February 1st, 2018
On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that:
"Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; and beneficiary information that did not match CMS's records. Just 1 percent of MAOs submitted 51 percent of the records with potential error(s). Some of these errors may raise concerns about the legitimacy of services documented in the data, such as records that lacked a beneficiary last name or a valid identifier for the billing provider."
Consequently, the OIG is recommending that CMS begins to address these 'potential' errors and require further information from Medicare Advantage Organizations (MAOs) to evaluate the data. Providers may likely see an increase in the number of records requests from MAOs' remember it is important to respond promptly to these requests.
Article Tags (click on a tag to see related articles)
Reimbursement Guides 2021 Edition
Find-A-Code's 2021 specialty specific Reimbursement Guides give you the coding, billing, and documentation support you need to get paid properly and keep it.
Medicare
Procedure & Supply codes
Documentation
Compliance
HCC information
ICD-10-CM codes
Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.
If you would like a specific article written on a medical coding and billing topic, please Contact Us.
contact
innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email: