Long-Term Care

Medical Reviews: How much scrutiny do your data face?

PPS Alert for Long-Term Care, May 1, 2009

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As federal spending on Medicare continues to increase, so does focus on Medicare billing errors and improper payments. ?CMS and the federal government are focused on controlling healthcare costs as baby boomers enter the Medicare system,? says Glenda Hynes, RN, RAC-CT, clinical reimbursement consultant in Westfield, MA. ?And recent economic changes make monitoring Medicare expenses even more vital.? Ultimately, increased pressure from the government has led to higher scrutiny of healthcare providers? information, and claims processing contractors are poised to recoup improper payments identified through medical reviews. ?Every provider, at one point or another, will undergo an audit,? says Wayne van Halem, AHFI, CFE, principal at WVH Consulting, LLC, in Atlanta. ?They are unavoidable, but knowing what to expect is a facility?s best protection.? Although understanding the medical review process and what fiscal intermediaries (FI) and Medicare ¬ administrative contractors (MAC) look for may not help you avoid an audit, knowing how much scrutiny your data face is essential to surviving one.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to PPS Alert for Long-Term Care.

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