Involves payment for items or services when there is no legal entitlement to that payment, and the health care provider has not knowingly and/or intentionally misrepresented facts to obtain payment
IE: Misusing codes on a claim, Charging excessively for services or supplies, Billing for services that were not medically necessary, Unbundling and billing individual components of service instead of the all-inclusive procedure

Question

19-12-2022
Business

Answered

Involves payment for items or services when there is no legal entitlement to that payment, and the health care provider has not knowingly and/or intentionally misrepresented facts to obtain payment
IE: Misusing codes on a claim, Charging excessively for services or supplies, Billing for services that were not medically necessary, Unbundling and billing individual components of service instead of the all-inclusive procedure

Answer :

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tutorconsortium634 tutorconsortium634 · Answer 1 · 2022-12-25T05:04:32-05:00

Abuse includes paying for items or services when there is no legal right to such payment and the Supplier has not knowingly or intentionally misrepresented the facts in order to obtain payment.

What audit can identify improper payments on Medicare beneficiary medical claims?

The mission of the Medicare Fee for Service (FFS) Recovery Audit Program is to efficiently detect and correct overpayments and underpayments to providers of health care claims provided to Medicare beneficiaries to prevent fraudulent Medicare.

What are the main signs of abuse?

Signs of physical abuse; Most children have cuts and bruises as part of the harsh environment. Signs of sexual abuse. Signs of emotional abuse. Signs of neglect.

Examples of abuse include: slapping, pinching, choking, kicking, pushing, and inappropriate use of drugs or restraints.

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