Congressional spending plan: What’s in it for healthcare, and what isn’t
Chief Healthcare Executive December 21, 2024
Proposed Rule Targets ’Highly Suspect‘ Billing in Shared Savings Program
HealthLeaders Media July 2, 2024
The rule is part of larger plan to address anomalous spending in the program.
KEY TAKEAWAYS
– An increase in SAHS claims for urinary catheters instigated the proposal.
– Payouts for codes related to SAHS claims will exclude calculations assessing ACO financial performance.
After noting a significant increase in highly suspect claims for Healthcare Common Procedure Codes (HCPCS), The Centers for Medicare & Medicaid Services (CMS) is proposing a new rule to crack down suspicious billing activity.
CMS officials have reported a significant increase in SAHS (significant, anomalous and highly suspect) claims for codes for urinary catheters, tips, and insertion supplies during 2023, and the corresponding HCPCS codes were flagged for SAHS billing.
The proposed rule will exclude payouts for...
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