decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Investigation Procedures / Administrative, Civil and Criminal Sanctions / Administrative Sanctions for Health Care Providers / Removal or Reduction of Periodic Interim Payment
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Article Overview
This article discusses OIG investigation procedures and related administrative sanctions for health care providers, with a focus on periodic interim payment. It outlines the general reimbursement framework, the role of the intermediary and CMS, and the administrative steps associated with revocation or reduction of payment status. The content is relevant to compliance staff, billing professionals, auditors, and providers who need a high-level understanding of how this payment method can be adjusted in response to provider conduct.
Why This Topic Matters
Understanding this topic helps providers and compliance teams recognize when reimbursement arrangements may be reviewed or altered and how administrative actions fit within broader oversight activity.
What You Will Learn
- How periodic interim payment functions as a reimbursement method
- What role the intermediary and CMS play in payment oversight
- How administrative review may occur before a payment change becomes final
- How provider conduct can relate to changes in reimbursement status
Who Should Read This
- Health care providers
- Compliance professionals
- Medical billing staff
- Auditors
- Revenue cycle teams
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