Part B News | Editors' Blog

by: Josh Poltilove Mar 16, 2016

Did your practice participate in the Office of Medicare Hearings and Appeals’ settlement pilot project? If so, we’d love to hear the story of how your practice fared — regardless of whether it agreed to a settlement and got out of the massive backlog of appeals at the administrative law judge level.

Please contact editor Josh Poltilove at jpoltilove@decisionhealth.com or (301) 287-2593.

New CMS overpayments lookback period: Is it six years – or 10?

by: Roy Edroso Feb 26, 2016

One of the few silver linings for providers in the final overpayments rule is that the “look-back” period within which CMS will go after provider overpayments was reduced to just six years. But that won’t necessarily stop federal prosecutors from going after them for longer.

Long-awaited CMS rule on overpayments gives 6-year lookback, specifies overcoding

by: Roy Edroso Feb 11, 2016

Four years after the proposed rule was issued, CMS has issued the final 60-day overpayment rule, formally called Reporting and Returning of Overpayments. It reduces the look-back period within which the agency can act on determinations that providers have received too much in Medicare funds but sets rigorous standards for determining what an overpayment is – including “over-coded” E/M claims.

Centene acts fast after nearly a million records go missing

by: Roy Edroso Jan 29, 2016

The 950,000 individual health records in its care may only be mislaid, but this health care company didn't wait to launch its breach program.

Look out for OIG in 2016 -- running out of targets, they may come for you

by: Roy Edroso Dec 29, 2015

Practice management expert Lisa Maciejewski-West looks at the recently released 2016 OIG Work Plan and deduces that the Office of Inspector General (OIG) seems to have beaten back the big fraudsters -- and may be coming after you next.

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