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Top Medicare Claim Denials and How to Prevent Them2018-10-16T23:56:53+00:00

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The Medicare hospice program continues to be under intense scrutiny by the Centers for Medicare & Medicaid Services (CMS) Medicare Center for Program Integrity (CPI) contractors, as well as the Health and Human Services’ (HHS) Office of General Inspector (OIG). CPI contractors include Medicare Administrative Contractors (MACs) that process and review claims, Comprehensive Error Rate Testing Contractors (CERT) that calculate Medicare improper payment rates, Recover Audit Program Contractors (RACs) that retroactively investigate and identify payment errors, and Zone Program Integrity Contractors (ZPICs) that investigate fraud, waste, and abuse.

According to the OIG Fiscal Year 2017 Work Plan, it is focusing its Medicare oversight efforts on identifying and offering recommendations to reduce improper payments, prevent and deter fraud, and foster economical payment policies. It has stated that future planning efforts will include additional oversight of hospice care, including oversight of certification surveys and hospice-worker licensure requirements, and evaluation of CMS’ Fraud Prevention System.

By having advance knowledge of the potential red flags that may come up at your agency, you can avoid denials, protect your agency, and proactively manage a successful business.

Download our latest guides and discover the top reasons for Medicare claim denials and how to prevent them!