OIG report on CCM errors a warning to tighten up billing before CMS does

Why This Topic Matters

The article highlights a federal audit of CCM billing, the categories of claim problems identified, and the prospect of CMS edits or other controls. It matters to organizations billing Medicare care management services because it points to areas where payment integrity, documentation, coordination, and internal review can affect compliance risk.

Article Sections

1. Compliance

   Introduces the OIG report, CMS’s response, and the general concern for practices billing chronic care management services.

2. 3 sources of trouble

   Summarizes the main categories of billing problems identified in the audit and the related payment and beneficiary cost-sharing issues.

3. Is it hopeless?

   Presents commentary on early program guidance, ongoing operational challenges, and the possibility of future claims-processing controls.

4. Two tips for safer CCM

   Reviews broad compliance themes for internal review, exclusion screening, and staff coordination before submitting claims.