The Centers for Medicare & Medicaid Services Could Improve Performance Measures Associated With the Fraud Prevention System We found that CMS's process for refining and enhancing FPS models needs improvement. Specifically, CMS could not track savings from administrative actions back to the individual FPS models that initiated the investigation because, according to CMS, that capability was not built into the FPS. In addition, CMS did not make use of all pertinent performance results because CMS did not (1) ensure that the adjusted savings Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) reported to CMS reflected amounts certified by the OIG and (2) evaluate FPS ... September 29, 2017 Medicare 0 0 Comment Read More »
Enhancements Needed in the Tracking and Collection of Medicare Overpayments Identified by ZPICs and PSCs This study continues OIG's body of work examining overpayments made by Medicare. Overpayments can be identified by a number of key players including providers and Medicare contractors. Recovering overpayments is critical to reducing improper payments in the Medicare program. Past OIG work found that overpayments referred by program safeguard contractors (PSCs) for collection did not result in significant recoveries to the Medicare program. As of 2012, CMS had transitioned the workload of most PSCs to six zone program integrity contractors (ZPICs). In 2016, CMS began transitioning the remaining PSCs ... September 29, 2017 Medicare 0 0 Comment Read More »
Your Online Reputation Is Costing You A Fortune. Here’s Why. In today’s technology-driven world, people check the internet for reviews before trying any product or service - including doctors. Physicians often overlook their online reputation but this is a huge mistake. Even a slightly negative online reputation can cost you a fortune. Believe it or not, nearly three-quarters of your patients will search for you online before ever calling in to make an appointment! Do you have the best online reputation possible? If not, you are costing yourself money everyday. A poor online reputation leads to lost patients and lost ... September 27, 2017 General 0 0 Comment Read More »
Latest Attempt at Repeal and Replace Falls Short Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again. While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) Read More... September 27, 2017 General, Insurance 0 0 Comment Read More »
Anthem’s Prediction of 30% Rise in Drug Costs for 2018 Raises Questions Health insurance giant Anthem predicts Californians will pop a lot more pills next year. To make the case for a hefty premium hike in the state’s individual insurance market, Anthem Blue Cross has forecast a 30% jump in prescription drug costs for 2018. Such a sharp increase is nearly double the estimates of two other big insurers, and it runs counter to industry trends nationally. Read More... September 27, 2017 Blue Cross, Insurance 0 0 Comment Read More »
