-
Posting Date: 01/19/2021
Coordination of Benefits Trading Partners
Section 2: Medicare Basics Coordination of Benefits Trading Partners COBC exclusively crosses over all claims to trading partners. “Trading partner” is defined as an issuer of an insurance policy that supplements Medicare or a state agency [...]
Read More -
Posting Date: 04/27/2015
Fraud and Abuse
Section 3: Fraud and Abuse Fraud and Abuse Table of Contents Fraud and Abuse Examples of Fraud Examples of Abuse [Return to Top] Fraud and Abuse Fraud occurs when there is an intentional deception or misrepresentation that an [...]
Read More -
Posting Date: 02/27/2014
Benefit Integrity
Section 3: Fraud and Abuse Benefit Integrity Providers have an obligation, under law, to conform to the requirements of Medicare. A key to avoiding fraud and abuse is the integrity of the provider as an entity and of each individual that is [...]
Read More -
Posting Date: 04/27/2015
Fundamentals of Medicare: Program Safeguard Contractor/Zone Program Integrity Contractor
Section 3: Fraud and Abuse Program Safeguard Contractor/Zone Program Integrity Contractor The primary goal of the PSC/ZPIC is to: identify cases of suspected fraud; develop them thoroughly and in a timely manner; and take immediate [...]
Read More -
Posting Date: 04/28/2015
Office of Inspector General
Section 3: Fraud and Abuse Office of Inspector General Table of Contents Office of Inspector General Compliance Programs Benefits of a Compliance Program Elements of A Compliance Program OIG Compliance Guidance Self-Discovery [...]
Read More -
Posting Date: 11/18/2020
Fraud and Abuse/Compliance Resources
Section 3: Fraud and Abuse Fraud and Abuse/Compliance Resources CMS Resources CMS IOM Publication 100-08, Program Integrity Manual OIG website OIG Fraud Prevention and Detection NGS Fraud and Abuse Resources Reviewed 6/4/2024
Read More -
Posting Date: 01/18/2022
Appeals Process
Section 3: Fraud and Abuse Appeals Process Table of Contents Appeals Process The Five Levels of Appeal Appeals Request Process First Level—Redetermination Second Level—Reconsideration Third Level—Administrative Law Judge [...]
Read More -
Posting Date: 04/28/2015
Comprehensive Error Rate Testing Process
Section 3: Fraud and Abuse Comprehensive Error Rate Testing Process Table of Contents Comprehensive Error Rate Testing Process What is CERT? Who Performs CERT? How Does It Work? CERT Information Available from CMS [Return to Top] [...]
Read More -
Posting Date: 04/28/2015
Registration of the Medicare Patient
Section 4: Getting Ready to Bill Medicare Registration of the Medicare Patient When a Medicare beneficiary receives hospital or other medical services, he/she is generally registered at the facility. It is possible that the patient may [...]
Read More -
Posting Date: 11/07/2024
MLN Connects® Newsletter: November 7, 2024
MLN Connects® Newsletter: November 7, 2024 Final Rules Physician Fee Schedule CY 2025 Final Rule Hospital Outpatient Prospective Payment System & Ambulatory Surgical Center Payment System CY 2025 Final Rule ESRD Prospective Payment [...]
Read More