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CMS Auditing Series 

Part IV of IV

One of the primary objectives of healthcare reform is to reduce the continued rise in healthcare spending. With the passage of the Patient Protection and Affordable Care Act, enforcement against Medicare and Medicaid fraud and abuse and other improper payments has gained traction. This fourth and final installment of the CMS Auditing Series will examine the possible penalties against audited providers. 

  CMS Auditing Series: More Stringent Provider Penalties 

More than 60 percent of the $3.4 billion in fraud recoveries expected by OIG for the period of October 2010 to March 201l will be the result of CMS audits. These audits can result in various penalties beyond simple reconciliation, including civil fines, criminal prosecution, and exclusion from federally funded healthcare programs. In this fourth and final installment of the CMS Auditing Series, HC Topics examines the provider penalties associated with CMS auditing. (Read more...)

  Dealing With the Medicare Doughnut Hole 

Recent provisions of the Patient Protection and Affordable Care Act are shrinking the Medicare Part D coverage gap, better known as the "doughnut hole." Through closing the upper and lower limit of the gap and implementing manufacture rebates, healthcare reform legislation aims to lower Medicare beneficiaries out of pocket expenses for the doughnut hole 75 percent by 2020. (Read more...) 

  The Expense of the ICD-10 Conversion 

The ICD-9 to ICD-10 conversion, federally approved in January of 2009, will continue to require significant direct and indirect costs, as providers, payers, and vendors must update information technology (HIT), educate and train staff, adjust operational workflows, and absorb the costs associated with increased documentation and the disruption of cash flow. This article discusses important considerations related to the transition. (Read more...)   

  Who is Marilyn Tavenner? 

As of December 2, CMS has a new leader: Marilyn Tavenner, who was nominated by President Barack Obama to replace Donald Berwick after his formal resignation. While many of Berwick's policies divided Republican and Democratic parties, Tavenner is thought to bring a new compromise to the feuding groups.  (Read more...)  

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