Strategic Health Solutions: The Latest CMS Contractor to Flex its Audit Muscles – Is Your Practice Ready to be Reviewed?
(May 9, 2013): “Strategic Health Solutions” is an Omaha, Nebraska-based company that provides professional health care education and audit services for both federal and state government agencies. I. Overview of Work Performed by Strategic Health Solutions: Strategic Health Solutions has been awarded multiple prime contracts by the Centers for Medicare and Medicaid Services (CMS). Areas worked by Strategic Health Solutions include: Supplemental Medical review Contractor. Medicare Outreach and Quality Assurance. Part D Formulary and Benefits Review Contractor. Medicare Secondary Payor Integration Contractor. Risk Adjustment Data Validation / Intake Medical Review Contractor. Medicare Part C and Part D Program Integrity Technical Assistance. Education Medicaid Integrity Contract (Education MIC) Task Order 1. Education ...
Changes to the Recovery Audit Contractor (RAC) Program will be Major in 2014.
(May 7, 2013): The Recovery Audit Contractor (RAC) program is slated to undergo significant changes in 2014. As discussed below, non-hospital health care providers and suppliers are likely to find the Medicare appeals process more complex than ever as RACs enter into the process in an effort to defend their denial decisions. I. Background of the RAC Program: The RAC program was first established as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The program’s stated purpose was to detect and correct improper payments made by the Medicare program to health care providers and suppliers. RACs were initially restricted ...
Does One of Your Employees Suffer from a Chronic Illness or Medical Condition? Consider the ADA When Assessing Their Request for Additional Medical Leave
[caption id="attachment_288" align="alignleft" width="150"] Are you acting reasonably when responding to request for leave from an employee with a chronic condition?[/caption] (March 19, 2013): It’s a fact of life – essentially all us will likely fall ill or develop a chronic medical condition at some point during our employment. Employees working in physician offices, home health agencies and for Durable Medical Equipment (DME) suppliers are no exception. When this occurs, owners and managers cannot forget their obligations under the American Disabilities Act (ADA) and its amendments under the Americans with Disabilities Act Amendments Act of 2008 (ADAAA). I. A Recent Decision by ...
Medicaid and CHIP Audits are Increasing Under CMS’ PERM Audit Program
(March 5, 2013): Providers participating in the Medicare and Medicaid programs are currently subject to audit by numerous federal and state regulatory and law enforcement agencies. Additionally, CMS has selected a number private contractors to handle various aspects of administrative integrity audits of claims submitted for payment by participating providers. Most recently, CMS has fully implemented its Payment Error Rate Program (PERM). An overview of the program and the claims reviewed as part of its mandate are set out below: I. Historical Background of the PERM Audit Program Payment Error Rate Program (PERM) audits are perhaps the least understood type of administrative audit routinely conducted by ...
Health Law ArticlesStrategic Health Solutions: The Latest CMS Contractor to Flex its Audit Muscles – Is Your Practice Ready to be Reviewed? Liles Parker Attorney to Speak at National Conference for Medical Office Professionals Changes to the Recovery Audit Contractor (RAC) Program will be Major in 2014. Does One of Your Employees Suffer from a Chronic Illness or Medical Condition? Consider the ADA When Assessing Their Request for Additional Medical Leave Liles Parker Attorney Achieves Recognition as a Certified Medical Compliance Officer Read More Posts From This Category
Dental Law ArticlesZPIC Audits of Specialty Dental Practices are Here! Is Your Dental Practice Ready? A “Credible Allegation of Fraud” Related to Medicare or Medicaid Services Will Result in Your Dental Practice Being Placed on “Suspension” or “Payment Hold.” Dental Practices Should Exercise Care Before Adopting Cloud Computing. Dental Audits: the New Enigma? Returning a Medicaid Dental Overpayment: Part II Read More Posts From This Category
Municipal Law ArticlesPeddling and Soliciting, Municipal Regulations These Issues Can be Complex. Is Your City Clear on these Points?
(January 8, 2013): As a general rule cities can regulate hawking, canvassing,... [Read more of this review]City Contracts and Arbitration
It is recommended that cities do not agree to arbitration, either voluntarily or... [Read more of this review]Hotel Occupancy Tax Funds – Management and Duty – Part III of III
(March 30, 2011): In Part I, the Hotel Occupancy Tax (“HOT”) was defined and... [Read more of this review]Read More Posts From This Category
Business & Transaction ArticlesA Recent False Claims Act Case Being Brought Against an Individual Physician has Resulted in a Record Recovery for the Government.
(February 12, 2013): The civil False Claims Act is the primary civil enforcement... [Read more of this review]What is Civil Fraud?
(November 29, 2012): Civil fraud cases are complex and can have substantial effects... [Read more of this review]Individual Liability for Medicare Overpayment Claims
Personal liability of individual owners of health care provider companies for claims... [Read more of this review]Read More Posts From This Category