tci Medicare Compliance & Reimbursement - 2011 Issue 7
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Article Overview
This article covers two compliance-focused developments affecting healthcare providers: CMS efforts to obtain responses to CERT medical review requests and New York Medicaid audit enforcement trends. It is relevant to providers, compliance teams, billing staff, and administrators who follow Medicare and Medicaid oversight, documentation review, and state-level program integrity activity. The piece also references advocacy and legislative responses aimed at shaping enforcement priorities.
Why This Topic Matters
It helps readers understand current enforcement and documentation-review pressure from federal and state programs, which can affect claim status, audit exposure, and compliance planning.
What You Will Learn
- How CMS is approaching follow-up on CERT medical review requests
- What types of Medicaid audit concerns are being reported in New York
- How provider coalitions are responding to state enforcement practices
- What legislative efforts are aimed at Medicaid program integrity oversight
Who Should Read This
- Healthcare providers
- Medical coders
- Billing and claims staff
- Compliance professionals
- Practice administrators
- Long-term care organizations
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