Blog - Tag archives for medicaid audit

On May 17, 2013, HHS published a rule change that will allow state Medicaid programs to use federal funds to data mine for erroneous and false claims. The rule change is expected to generate an estimated $60 million in additional recoveries over the next decade. In order to obtain a portion of the approximately $12 Read more →

Tags : medicaid audit , Medicare Audit

In order to avoid erroneous billing practices for “New Patient” Evaluation and Management services, CMS issued Change Request 8165 which informs Medicare contractors about changes to Medicare’s Common Working File system that detects errors in billing.  According to Medicare manuals, “New Patient” is defined as: a patient who has not received any professional services, i.e., Read more →

Tags : medicaid audit , Medicare Audit