Tag: Medicare Compliance

Mechanical Ventilation Coding

Avoiding Overpayments Through Accurate Mechanical Ventilation Coding

 The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently conducted a review of Medicare Severity Diagnosis Related Groups (MS-DRGs) that required more than 96 consecutive hours of mechanical ventilation. The audit focused on compliance with Medicare payment requirements and accurate Mechanical Ventilation Coding and code assignment. A total of […]
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RCM Compliance Challenges

Top 10 Revenue Cycle Management Compliance Challenges

Revenue cycle management (RCM) is the financial backbone of any medical practice, ensuring timely reimbursement while maintaining compliance with ever-evolving regulations. However, many practices unknowingly face significant compliance risks that can lead to claim denials, audits, financial penalties, and even legal consequences. Common pitfalls include billing and coding errors, fraud and abuse violations, HIPAA breaches, […]
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Medicare Overpayment Rule

Navigating the 2025 Medicare Overpayment Rule Changes

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule significantly changing how healthcare providers must handle Medicare overpayments. The new Medicare Overpayment Rule, effective January 1, 2025, is part of the 2025 Physician Fee Schedule Final Rule and impacts Medicare Parts A/B (Traditional Medicare) and C/D (Medicare Advantage and Prescription Drug Plans). […]
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Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

A leaked CMS report targeting HCA Healthcare-owned Good Samaritan Hospital in California warns the hospital to fix Medicare noncompliance issues or risk termination. A leaked CMS report put HCA Healthcare-owned Good Samaritan Hospital in California at risk of program termination by October if they fail to fix Medicare noncompliance issues that resulted in patient harm. […]
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