tci Medicare Compliance & Reimbursement - 2012 Issue 4
Industry Notes: Medicare Offers Handy Tool to Ease Preventive Service Billing Burden
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Article Overview
This industry note brings together several Medicare and Medicaid compliance topics for coding and billing professionals. It highlights a CMS preventive services quick reference resource, discusses government enforcement activity tied to referral arrangements, and summarizes work-plan and audit developments affecting Medicaid providers. The article is relevant to billers, compliance staff, auditors, and healthcare organizations that handle preventive services and public-program reimbursement.
Why This Topic Matters
The piece helps readers track practical billing support from CMS while also flagging enforcement and audit trends that can affect reimbursement, claims handling, and compliance operations. It is useful for organizations that bill preventive care to Medicare or manage Medicaid payment integrity issues.
Article Sections
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CMS Preventive Services Quick Reference
Overview of a CMS reference chart for preventive services billing, including the broad categories of services it addresses and the type of information it provides to billers.
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Four Doctors Nailed for Alleged Kickback Scheme
Summary of a federal enforcement matter involving alleged referral-related payments and related healthcare fraud allegations.
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Watch Out For This OIG Work Plan Item
Discussion of a HHS OIG work-plan topic focused on Medicaid overpayments, credit balances, and related review priorities.
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The Medicaid RACs to Debut Soon
Coverage of the rollout of Medicaid recovery audit activity and the types of facility operations and transactions that may be subject to review.
What You Will Learn
- What kinds of Medicare preventive service guidance CMS has made available
- How the article frames Medicaid overpayment and credit-balance concerns
- What enforcement and audit themes are highlighted for healthcare providers
- Which broad compliance areas are associated with Medicaid RAC reviews
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle professionals
- Healthcare administrators
- Auditors
- Physician practices
- Long-term care facilities
Codes Discussed
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