The settlement demonstrates that enforcement risk is real and substantial, but it also highlights an opportunity. Medicare Advantage oversight does not require years of new rulemaking or experimental pilots because the technical capability to validate documentation at scale already exists and can be deployed today.
Capital audits can create financial pressures for facilities. However, with proactive risk mitigation, nursing homes can safeguard their financial stability and ensure continued compliance.
By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.
Adding generative AI and other AI tools to coding and chart review practices streamlines a complex process and better positions plans for risk adjustment audits.
When CMS overpays for services, providers and commercial payers are responsible for paying the agency back, and at times, they are on the hook for millions of dollars. But technology can help healthcare stakeholders catch the mistakes that lead to overpayments, thereby reducing unnecessary costs.
CMS recently revealed that the Patient-Driven Payment Model – intended to be revenue-neutral as compared to the previous payment model – increased reimbursements to SNFs last year by more than $1.7 billion, raising the specter of potential payment reviews around the corner.
The Office of the Inspector General will audit Medicare Part B telehealth services to detect potential vulnerabilities and ensure compliance with regulatory requirements. To prepare, providers must first take stock of their programs and conduct audits of their own, experts say.
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.