High-Risk Areas in Medicare Billing - Compliance Auditing Tools for Hospitals and Health Systems
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Master List of Risk Areas and Compliance Tools

Alphabetical Listing of Risk Areas

Front-End Processes

Central Processes

Back-End Processes

Special High-Risk Areas

Compliance Profiles


Alphabetical Listing of Risk Areas

Advance Beneficiary Notices

Bad Debt

Billing for Hospital Inpatient Services

Billing for OPPS Hospital Outpatient Services

Certification and Recertification

Clinical Trials Reimbursement

Common Coding Errors (including Upcoding and Unbundling)

Copayments and Deductibles

Critical Access Hospitals (CAH)

Diagnostic X-Rays in the Emergency Room


Drugs, Biologicals and Radiopharmaceuticals

False Claims Exposure

Hospital-Acquired Conditions/Present-on-Admission Indicators

Inpatient-Only Procedures


Length of Stay Issues

Long-Term Care Hospitals

Implantable Medical Devices

Medical Necessity

Medicare Cost Reports

Medicare Secondary Payer

‘Never’ Events

Observation or Admission

Outlier Payments

Outpatient Rehabilitation Facilities

Overpayments and Credit Balances

Physician Supervision of Outpatient Diagnostic and Therapeutic Services

Records Management

The Three-Day Payment Window (72-Hour Rule)

Transfers and Discharges


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