Appropriate of care and setting Duplicate/overlapping payments (multiple types) Inpatient coding (i.e., Diagnosis-Related Group [DRG]) Mother/baby duplicates Bill audit Inpatient/outpatient unbundling Inpatient reimbursement error Balance billing overpayments Readmissions and transfers Financial review/credit balance events/Hospital-Acquired Conditions Medicare deductible/coinsurance errors (HACs) Medical necessity Covered benefit (exclusion) Duplicate/overlapping payments Bill audit Unbundling ESRD issues Downcoding High Cost Drug (HCD) errors Radiology billing errors Financial review/credit balance Outpatient Anesthesia billing errors Medicare coinsurance errors National Correct Coding Initiative (NCCI) Infusion therapies coding errors Specialized therapies (occupational therapy, speech pathology, physical therapy) Excess/duplicate days LTC/hospice duplicate days Patient-pay underreporting Overlapping services included in per diem rate LTC Bed hold days Financial review/credit balance Date of death Cost report auditing Crossover billing errors Unit billing errors Duplicate pharmacy/physician therapy Duplicate payment/early refill 340b overpayments Pharmacy Return to stock overpayments patterns Other Third Party (OTB) coordination of benefits (COB) issues Duplicate/excess billing Medicare-Medicaid (Medi-Medi) duplicate Home Health payment and COB Excess supply utilization Medical necessity Duplicate procedure billing Modifier errors resulting in overpayment Medi-Medi duplicate NCCI Billing for services not delivered Unit billing errors Upcoding of Evaluation and Management Multiple/bilateral procedures/co-surgeon Professional (E&M) services cost reduction assistant surgeon Crossover duplicates Medical necessity Unbundling Place-of-service errors Global codes Professional/technical component errors Unbundling Medically unlikely and excess billing Duplicate Upcoding Radiology/Laboratory Professional/technical component errors Medical necessity NCCI Orphan lab Upcoding Medi-Medi duplicates
Inpatient Appropriate of care and setting Inpatient coding (i.e., Diagnosis-Related Group [DRG]) Bill audit reimbursement error Readmissions and transfers events/Hospital-Acquired Conditions (HACs) Duplicate/overlapping payments (multiple types) Mother/baby duplicates Inpatient/outpatient unbundling Balance billing overpayments Financial review/credit balance Medicare deductible/coinsurance errors Medical necessity Covered benefit (exclusion) Outpatient Duplicate/overlapping payments Unbundling Downcoding Radiology billing errors Anesthesia billing errors National Correct Coding Initiative (NCCI) coding errors Bill audit ESRD issues High Cost Drug (HCD) errors Financial review/credit balance Medicare coinsurance errors Infusion therapies Specialized therapies (occupational therapy, speech pathology, physical therapy) LTC Excess/duplicate days Patient-pay underreporting Bed hold days Date of death Crossover billing errors LTC/hospice duplicate days Overlapping services included in per diem rate Financial review/credit balance Cost report auditing Pharmacy Unit billing errors Duplicate payment/early refill Return to stock overpayments Other Third Party (OTB) coordination of benefits (COB) issues Duplicate pharmacy/physician therapy 340b overpayments patterns Home Health Duplicate/excess billing Excess supply utilization Medicare-Medicaid (Medi-Medi) duplicate payment and COB Medical necessity Professional Duplicate procedure billing Medi-Medi duplicate Billing for services not delivered Upcoding of Evaluation and Management (E&M) services Crossover duplicates Unbundling Global codes Professional/technical component errors Modifier errors resulting in overpayment NCCI Unit billing errors Multiple/bilateral procedures/co-surgeon cost reduction assistant surgeon Medical necessity Place-of-service errors Radiology/Laboratory Unbundling Duplicate Professional/technical component errors NCCI Upcoding Medically unlikely and excess billing Upcoding Medical necessity Orphan lab Medi-Medi duplicates