decisionhealth Newsletters, Part B News - 2010 Issue 10 (October)
3 'error-prone' provider tips to minimize risk of overpayments
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Article Overview
This article reviews a federal audit finding that identified Medicare providers with repeated claim errors and discusses the broader compliance response from OIG and CMS. It is aimed at providers, practice managers, auditors, and coding/compliance staff who want to understand why certain claims draw heightened scrutiny and what types of internal monitoring practices are commonly recommended. The article also points readers toward public error-focused resources from Medicare contractors and discusses general claim-review practices without providing premium-level detail.
Why This Topic Matters
Repeated claim errors can trigger increased scrutiny, overpayment demands, and a stronger focus on billing and coding processes. Understanding the compliance themes in the article can help organizations assess their internal audit practices and monitor external error trends.
Article Sections
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Federal audit findings and provider scrutiny
Summarizes the audit activity discussed in the article and the broader federal attention on providers with recurring claim issues. Covers the roles of OIG, CMS, and Medicare claim review programs.
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Self-audit and internal review practices
Describes general approaches for routine claim review within a practice. Focuses on internal monitoring, trend review, and assigning responsibility for audit activities.
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Using Medicare contractor resources
Explains how public information from Medicare contractor websites can help identify common error trends. Discusses the relationship between contractor-posted findings and broader CMS review activity.
What You Will Learn
- How federal audit programs can identify providers with recurring claim errors
- Why internal claim monitoring is important for compliance readiness
- How public Medicare contractor resources can inform a practice’s review priorities
- What types of organizational practices support ongoing billing and coding oversight
Who Should Read This
- Physicians and group practices
- Practice administrators
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle managers
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