How can providers be involved in developing criteria for defining a payment error?
Ohio KePRO is required to engage the hospital community in these type of discussions. The rules as to what Medicare pays for are defined in law and regulation. However, the nature of evidence of a payment error, such as what constitutes documentation for specific issues, and the appropriate ways to interpret patterns resulting from analysis of paid claims, do represent opportunities for providers to offer information and advice to Ohio KePRO. Providers can and should play a continuing role in dialogue with Ohio KePRO, discussing how it can interpret the information at hand. As Ohio KePRO and providers examine how the criteria are applied in specific cases, they will occasionally identify areas where the criteria are vague or need greater precision and clarification.
