How much will the facility have to repay for the overage

Reference no: EM133371626

Case Study: The HIM Coding Manager has reviewed recent claims submitted and finds a demand letter of fraudulent overpayment of 200 claims, which had their laboratory charges unbundled when submitted for payment. As a result, the facility was overpaid by $85.00 on each claim. The HIM Director pleads their case and explains that this is a first-time offense and was caused by three new coders. OIG accepts their appeal but requires them to repay the overage and to a corrective action audit plan for the Coding Compliance Plan and that it be submitted to OIG for review.

Questions: In a Word document, answer the following questions:

How much will the facility have to repay for the overage?
What would have been the unbundling penalty against the facility if OIG had enforced the penalty?
What is unbundling, calculate the repayment, and calculate what the additional penalty would have cost the facility.
What type of corrective actions should be included in the Coding Compliance Plan that should correct this issue?

Reference no: EM133371626

Questions Cloud

Combat complex coordinated terrorist attacks : What is one thing that citizens can do to help government officials combat complex coordinated terrorist attacks?

What could be the factors affecting disciplined thinking : Discuss the wisdoms that philosophers may seekin relation to human life and universe? Consider the differences and similaritiesof these wisdoms

Committed terrorist actions : How can States identify, investigate, and apprehend those individuals seeking to commit or already have committed terrorist actions

Explain the distinction between food quality problems : Explain the distinction between the following food quality problems and describe the relative degree of risk each poses to the health of consumers of these

How much will the facility have to repay for the overage : How much will the facility have to repay for the overage? What would have been the unbundling penalty against the facility if OIG had enforced

Which government body plays a critical role in policy : Between the Executive, Legislature, and Judiciary, which government body plays a critical role in policy development? Include reference

Which agency do you think is most important to you : Which agency do you think is most important to you as a consumer? Who does this agency benefit most and can one report fraud/scams and if so

Discuss any two methods of sanitizing food contact surfaces : Discuss any two methods of sanitizing food contact surfaces. What does clean-in-place method mean? What are the general food safety rues that must be

Who is responsible for making the necessary changes : Is there a primary patient and family centered care challenge in this scenario? If so, what is it? If not, then what elements in this scenario

User Account

All Pages