Duplicate billing Orphan transportation Medicare COB/unbundling. For dual eligibles, HMS finds Medi-Medi duplicates Unbundling ambulance transports that should be covered under the hospital ER or inpatient stay separately billed to Medicaid. Ambulance Orphan transport. HMS analyzes each recipient’s claims to identify transportation claims with no other medical services on that date. Excess utilization Prior authorization HMS identified more than discrepancies $10 million in overpayments Unit billing errors in the first year of one Services do not Nonqualified staff behavioral health audit that treatment plan Billing for services not we are conducting on behalf Documentation issues delivered of a state Medicaid program Behavioral Health for the following issues: Medical necessity nonqualified staff performing issues counseling, missing documentation, noncovered services, and medical necessity. Excess utilization Prior authorization care. In nine discrepancies months, HMS auditors Unit billing errors identified more than $3 Services do not match Nonqualified staff million in overpayments to treatment plan Home and Billing for services not Home and Community-Based Documentation issues Community-Based delivered Service providers in one Waiver Services southern Medicaid program Medical necessity for the following issues: issues missing documentation, excess hours, and noncovered services.
Ambulance Duplicate billing Medi-Medi duplicates Orphan transportation Unbundling Medicare COB/unbundling. For dual eligibles, HMS finds ambulance transports that should be covered under the hospital ER or inpatient stay separately billed to Medicaid. Orphan transport. HMS analyzes each recipient’s claims to identify transportation claims with no other medical services on that date. Behavioral Health Excess utilization Unit billing errors Nonqualified staff Billing for services not delivered Medical necessity issues Prior authorization discrepancies Services do not treatment plan Documentation issues HMS identified more than $10 million in overpayments in the first year of one behavioral health audit that we are conducting on behalf of a state Medicaid program for the following issues: nonqualified staff performing counseling, missing documentation, noncovered services, and medical necessity. Home and Community-Based Waiver Services Excess utilization Unit billing errors Nonqualified staff Billing for services not delivered Medical necessity issues Prior authorization discrepancies Services do not match treatment plan Documentation issues care. In nine months, HMS auditors identified more than $3 million in overpayments to Home and Community-Based Service providers in one southern Medicaid program for the following issues: missing documentation, excess hours, and noncovered services.
ScopeOfWork-RAC.docx