Duplicate/excess Medi-Medi duplicate Medi-Medi improper billing payment payments. Review ensures that if a period of care is Excess supply COB covered by Medicare, all utilization services covered under the 60-day Medicare period of care (i.e., supplies, drugs, Home Health and therapy) are not billed and paid by Medicaid. HMS has recovered more than $10 million for one state client through our home health review and appeal process. Duplicate procedure Modifier errors HMS has targeted more than billing resulting in $83 million in claims for E&M overpayment upcoding review in 2011 Medi-Medi duplicate alone. NCCI Billing for services not HMS annually identifies delivered Unit billing errors millions of dollars in NCCI Upcoding of E&M Multiple/bilateral Professional and Medically Unlikely Edit services procedures/co-surgeon issues across multiple clients. cost reduction Crossover duplicates assistant surgeon Unbundling Medical necessity Global codes Place-of-service errors Professional/technical component errors Unbundling Medically unlikely and HMS typically identifies more excess billing than $1 million for clients in Duplicate improper radiology Radiology/ Upcoding Professional/technical component billing. Laboratory component errors Medical necessity NCCI Orphan lab Upcoding Medi-Medi duplicates Upcoding Medically unlikely HMS has recovered more than $14 million related to Duplicate billing Drug service ratio Dental dental services on behalf of NCCI Age inappropriate Medicaid agencies. Split billing Duplicate billing Unbundling HMS’s algorithms identify rental payments in excess of Medi-Medi duplicate Upcoding capped rental limits while billing Rental cap issues incorporating Medicare Utilization in excess of Services billed and not coverage issues. Durable Medical program limits delivered HMS typically finds Equipment (DME) code” “Miscellaneous documentation errors on review more than 50% of targeted claims. For our clients, HMS has found payments well in excess of these limits.
Home Health Duplicate/excess billing Excess supply utilization Medi-Medi duplicate payment COB Medi-Medi improper payments. Review ensures that if a period of care is covered by Medicare, all services covered under the 60-day Medicare period of care (i.e., supplies, drugs, and therapy) are not billed and paid by Medicaid. HMS has recovered more than $10 million for one state client through our home health review and appeal process. Professional Duplicate procedure billing Medi-Medi duplicate Billing for services not delivered Upcoding of 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 HMS has targeted more than $83 million in claims for E&M upcoding review in 2011 alone. HMS annually identifies millions of dollars in NCCI and Medically Unlikely Edit issues across multiple clients. Radiology/ Laboratory Unbundling Duplicate Professional/technical component errors NCCI Upcoding Medically unlikely and excess billing Upcoding Medical necessity Orphan lab Medi-Medi duplicates HMS typically identifies more than $1 million for clients in improper radiology component billing. Dental Upcoding Duplicate billing NCCI Split billing Medically unlikely Drug service ratio Age inappropriate HMS has recovered more than $14 million related to dental services on behalf of Medicaid agencies. Durable Medical Equipment (DME) Duplicate billing Medi-Medi duplicate billing Utilization in excess of program limits “Miscellaneous code” review Unbundling Upcoding Rental cap issues Services billed and not delivered HMS’s algorithms identify rental payments in excess of capped rental limits while incorporating Medicare coverage issues. HMS typically finds documentation errors on more than 50% of targeted claims. For our clients, HMS has found payments well in excess of these limits.