tci Medicare Compliance & Reimbursement - 2017 Issue 16

Compliance: Shoddy Notes Factor Greatly in Incorrect Claims, CERT Report Says

‘Two Midnight’ rule contributes to a decrease in 2016’s improper payment rate. The news is rife with stories of practices billing Medicare improperly. But on the upside, some measures instigated by CMS to assist providers and lower the improper payment rates are working. The 2016 Medicare Fee-for Service (FFS) improper payment rate dropped to 11.2 percent from 12.1 percent in 2015, the second year in a row with declines, according to the latest Comprehensive Error Rate Testing (CERT) report, which CMS released last month. Background: “It is important to note that the improper payment...

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