HHS begins second phase of HIPAA audits The second phase of audits for compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations is underway. The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) selected a total of 167 health plans, health care providers and health care clearinghouses to be audited. Selected physician practices would have received an email from OCR on July 11. The email may be incorrectly classified as spam, so check your spam and junk folders to make sure you didn't miss it. The 2016 phase 2 HIPAA audit program ... August 5, 2016 General HIPAA, HIPAA Privacy Rule, Audits 0 0 Comment Read More »
DHCS expands phone system for Medi-Cal recipients in wake of critical June audit report In June, the California State Auditor’s office released a report that found the Medi-Cal phone system for beneficiaries to be “severely deficient”; the auditor urged the Department of Health Care Services (DHCS) to make upgrades. The report found that DHCS had an average of 12,500 unanswered calls each month, between February 2014 and January 2015. Some months, the telephone system rejected as many as 45,000 calls. On September 30, 2015, DHCS announced that the ombudsman phone system has been expanded. The new system is expected to improve data collection, reduce ... October 14, 2015 Medi-Cal Medi-Cal, Audits 0 0 Comment Read More »
Noridian announces new audits Noridian, California's Medicare administrative contractor, has announced it will be conducting service-specific targeted audits of procedure codes 99205 and 99233 when rendered by providers with specific specialties: 99205 performed by cardiology (Centers for Medicare and Medicaid Services specialty designation 06) and pulmonary (29) 99233 performed by internal medicine (11) and hematology/oncology (83) Noridian conducts these targeted reviews based on data analysis. An analysis of these procedure codes, when performed by physicians in these specialties, indicated a higher utilization by California providers when compared ... August 5, 2015 Medicare Medicare, Noridian, Audits 0 0 Comment Read More »
California Medical Association supports the Fair Medical Audits Act of 2015 The California Medical Association (CMA) issued a strong endorsement for the “Fair Medical Audits Act of 2015,” introduced today by U.S. Representative George Holding of North Carolina. The legislation addresses many concerns that physicians have with regard to the extraordinary lack of transparency and expensive, time-consuming and often unfair processes that plague the current Medicare audit program. Representative Holding declared it time to fix the broken audit program: “Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency ... May 26, 2015 Medicare Federal Legislation, Medicare, Recovery Audit Program, Advocacy, Audits 0 0 Comment Read More »
Medicare RAC court case keeps collections on uncertain footing The U.S. Court of Appeals for the Federal Circuit issued a decision in early March in a case filed by one of the Medicare Recovery Audit Contractors (RAC) after the Centers for Medicare and Medicaid Services (CMS) changed the timing for the payment of contingency fees on collections. The decision means the auditing program will be put on hold until CMS determines how to contract with its RACs. The RAC program is responsible for identifying fraud and waste in the Medicare system by detecting improper Medicare payments. Since 2008, when ... March 18, 2015 Medi-Cal, Medicare Centers for Medicare and Medicaid Services, Medicare, Recovery Audit Contractor, Audits 0 0 Comment Read More »
Medi-Cal audits began in September The California Department of Health Care Services (DHCS) has begun post-payment claims review of Medi-Cal claims in California. The purpose of this audit is to identify and correct improper Medicaid payments through the collection of overpayments and reimbursement of underpayments made on claims for health care services provided to Medicaid beneficiaries. The program will enable the Centers for Medicare and Medicaid Services (CMS) to implement actions that will prevent future improper payments in all 50 states. DHCS has contracted with Health Management Systems, Inc. (HMS) to act as the Recovery ... September 18, 2014 Medi-Cal Department of Health Care Services, DHCS, Medi-Cal, Audits 0 0 Comment Read More »
CMS must provide better oversight to prevent duplicate audits says GAO study A newly released study by the federal General Accounting Office (GAO) found that the Centers for Medicare and Medicaid Services (CMS) needs to provide better oversight and guidance for provider payment auditors to prevent duplicative post-payment claims review audits. Several types of Medicare contractors conduct postpayment claims reviews to help reduce improper payments: Medicare Administrative Contractors, which process and pay claims; Zone Program Integrity Contractors, which investigate potential fraud; Recovery Auditor Contractors, tasked with identifying on a postpayment basis improper payments not previously reviewed by other contractors; and the Comprehensive ... August 21, 2014 General CMS, Insurance/Reimbursement, Medicare, Audits 0 0 Comment Read More »
