Be prepared: Medicare auditors increase scrutiny.
The Centers for Medicare and Medicaid Services (CMS) is pushing its auditors to be more aggressive in reviewing hospital claims. CMS has set targets for how many claims the auditors should review. Auditors are encouraged to use extrapolation for denials when they find a pattern of erroneous claims. CMS has approved more than 570 diagnosis related group (DRGs) for medical necessity review.
D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics*; D003953:Diagnosis-Related Groups; D004469:Economics, Hospital; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D016134:Organizational Policy; D014481:United States