Corporate Compliance

Transmittals and MLN Matters articles: CMS instructs on implementation of fraud prevention predictive modeling prepayment edits and more

Medicare Insider, May 15, 2012

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CMS instructs on implementation of fraud prevention predictive modeling prepayment edits

On May 11, CMS issued a transmittal that implements the requirements developed under CR 7669, Transmittal 1049, and to make the changes to the CWF and shared systems that will allow the Fraud Prevention System (FPS) to review claims approved for payment by CWF and to make a payment determination that is returned to the shared systems for appropriate action with as minimal impact on the current claims flow as possible.
 
Effective date: January 7, 2013

Implementation date: Analyze, design, and testing: October 1, 2012. Coding, testing, and implementation: January 7, 2013

View transmittal R1089OTN.

CMS replaces transmittal on reporting of recoupment for overpayment on RA

On May 10, CMS replaced transmittal R993OTN, containing instructions for the FISS, MCS and VIPs to replace the HIC number being sent on the RA with the Patient Control Number received on the original claim.

View transmittal R1088OTN.
 
CMS replaces transmittal on new FISS edit to review OPPS payments exceeding charges
 
On May 4, CMS replaced transmittal R2461CP, containing an instruction for contractors to verify claims with OPPS payments that meet a reimbursement amount greater than submitted charges for claims on or after October 1, 2012.
 
Effective date: October 1, 2012
Implementation date: October 1, 2012

View transmittal R2463CP.

 



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