CMS announced a proposed rule for Stage 2 requirements for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of American Recovery and Reinvestment Act of 2009, eligible health care professionals (EPs), eligible hospitals and Critical Access Hospitals can qualify for […]

2011 Medicare Part D Improper Payment Error Rate For fiscal year (FY) 2011 reporting, HHS will report its baseline composite Part D improper payment error rate estimate of 3.2 percent. This rate is reported in the HHS FY 2011 Agency Financial Report (AFR), and is based on Calendar Year (CY) 2009 final Part D payments. […]

2011 Medicare Advantage (Part C) Improper Payment Error Rate For FY 2011, CMS is reporting a Part C composite improper payment rate estimate of 11 percent, based on CY 2009 payments. This represents a three percentage point reduction from the FY 2010 Part C composite improper payment rate of 14.1 percent. This improvement can be […]

2011 Original Medicare Improper Payment Error Rate The 2011 Original Medicare FFS program improper payment rate was 8.6 percent. While CMS continued to review claims according to a significantly revised and improved methodology as implemented in 2009 in consultation with the Health and Human Services Office of Inspector General (OIG), the methodology was further refined […]

2011 Medicaid Improper Payment Error Rate The 2011 Medicaid improper payment error rate is 8.1 percent. This represents a drop in the improper payment rate from 2010 (9.4 percent).[1] CMS measures Medicaid improper payments through the Payment Error Rate Measurement (PERM) program and produces state and national-level error rates for each program. The error rates […]

Procedures That Will be Paid Only as Inpatient for CY2012 This is a zip file for download. CPT® license agreement required.   2012 OPPS Final Addenda [ZIP, 1.54MB] (The 2012 Inpatient Only List is here as Addendum E.)  

According to CMS, this final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from continuing experience with this system. This final rule with comment period, describes the changes to the amounts and factors used to determine the payment rates for Medicare hospital […]

MEDICARE PREMIUMS AND DEDUCTIBLES FOR 2012 MEDICARE PART A: Medicare Part A premiums will be increasing by just $1 per month, and the deductible will increase by just $24. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, about 99 percent of Medicare beneficiaries do not pay […]

The OIG Work Plan 2012 The Office of Inspector General’s Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. The Work Plan includes projects planned in each of the […]