CMS issues revised provider and supplier ADR limitations *

USA - April 8 2013
On April 3, 2013, CMS issued revised provider and supplier additional documentation request (ADR) limitations for the Recovery Audit Contractor (RAC)…

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MedPac issues FY 2014 payment recommendations for inpatient and outpatient hospitals, LTCHS, hospices and ASCs *

USA - January 22 2013
The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency established to advise Congress on issues affecting the…

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GAO recommends strengthening Medicare prepayment edits *

USA - December 17 2012
On December 10, 2012, the Government Accountability Office (GAO) released a report on the use of prepayment edits in the Medicare program and CMS’ oversight of Medicare Administrative Contractors' (MACs) use of these edits.

Co-authors: Sara Kay Wheeler.

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OIG finds that more than $1 billion in inappropriate Medicare payments were made to SNFs in 2009 *

USA - November 19 2012
The OIG recently issued a report (OEI-02-09-00200) concerning improper skilled nursing facility (SNF) Medicare payments in calendar year 2009 (the Report).

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OIG issues second evaluation on excluded individuals participating in Medicaid managed care provider networks *

USA - October 8 2012
On September 27, 2012, the OIG issued its second evaluation (OEI-07-09-00632) on excluded individuals who were employed by service providers participating in Medicaid managed care provider networks in 2011 (the Report). 

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