RevCycle Intelligence July 1, 2024
A proposed rule from CMS looks to address “significant, anomalous, and highly suspect” billing impacting ACO reconciliation in the Medicare Shared Savings Program.
CMS has proposed a rule to address “significant, anomalous, and highly suspect” billing activity within the Medicare Shared Savings Program, including durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) billing.
Slated to be published to the Federal Register on July 3rd, the proposed rule aims to mitigate the impact of the billing activity in question as it relates to the reconciliation of accountable care organization (ACO) payments in calendar year (CY) 2023.
In CY 2023, CMS said it has observed what it calls SAHS (significant, anomalous, and highly suspect) billing for the Healthcare Common Procedure Coding System...
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