The U.S. Department of Health and Human Services Office of Inspector General has issued its semiannual report to Congress covering work it has performed from October 1, 2021-March 31, 2022. Highlights of the report include the noncompliant reporting of diagnosis codes by Medicare Advantage (MA) plans. This is significant because the diagnosis codes submitted to Medicare by MA plans are used in CMS’s risk adjustment program which impacts payer reimbursement. The report outlines several MA plans that were audited, the OIG’s findings, and the estimate of millions of dollars in overpayments for improper submission of diagnosis codes.
Other significant findings reported were Medicare’s overpayment of $636 million for neurostimulator implantation surgeries due to noncompliance with Medicare requirements for billing, and an estimated $117 million over 4 years improperly paid for durable medical equipment, prosthetics, orthotics, and supplies provided to hospice beneficiaries.
You can find the report here: Spring 2022 Semiannual Report to Congress
Denise serves as the Senior Vice President at Denial Research Group – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a Master’s degree in Management Information Systems from the University of Illinois, Springfield.
Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing. Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level.
Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials.