Improper Payment Reporting Criteria November 25 2022
Improper Payment Reporting Criteria The Payment Integrity Information Act of 2019 defines significant improper payments as either: (i) improper payments greater than $10 million and over 1.5 percent of all payments made under that program, or (ii) improper payments greater than $100 million. The Medicare Fee-For-Service (FFS), Medicare Part C, Medicare Part D, Medicaid, Children’s Health Insurance Program (CHIP), and Affordable Care Act Health Insurance Exchange Advance payment of the Premium Tax Credit (APTC) program are susceptible to significant improper payments. What You Need to Know: Improper payments represent payments that do not meet program requirements. The vast majority of improper payments occur in situations where there was an unintentional payment error or a reviewer cannot determine if a ...read more
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