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 ...
Predictive Modeling is Proving to be an Invaluable Targeting Tool for ZPIC Audits and RAC Audits.
(February 14, 2013): With the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Department of Justice (DOJ) and the Department of Health & Human Services, Office of Inspector General (HHS-OIG) were allocated dedicated funding to be devoted to the identification, prevention and prosecution of health care fraud. These law enforcement agencies were given sufficient funding to significantly ramp-up the number of investigations and prosecutions for violations of civil and criminal fraud violations. Over the last 15 years, various additional statutes have been passed (such as the Affordable Care Act (ACA)) which have provided both new investigation and ...
Health Law Articles
CMS Issues Instructions on the Impact of Sequestration on Survey and Certification Activities – How Will it Affect Providers?(May 20, 2013) In April, 2013, CMS issued S&C: 13-23-ALL which discusses the...
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...
Liles Parker Attorney to Speak at National Conference for Medical Office Professionals(May 8, 2013): Robert W. Liles, Managing Partner at Liles Parker, has been...
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...
Does One of Your Employees Suffer from a Chronic Illness or Medical Condition? Consider the ADA When Assessing Their Request for Additional Medical LeaveAre you acting reasonably when responding to request for leave from an employee with...
Read More Posts From This CategoryDental Law Articles
ZPIC Audits of Specialty Dental Practices are Here! Is Your Dental Practice Ready?(January 18, 2013): Specialty dental practices around the country are receiving audit...
A “Credible Allegation of Fraud” Related to Medicare or Medicaid Services Will Result in Your Dental Practice Being Placed on “Suspension” or “Payment Hold.”(December 31, 2012): Over the last year, many dentists, orthodontists and oral...
Dental Practices Should Exercise Care Before Adopting Cloud Computing.(December 30, 2012): Generally speaking, from the standpoint of a dental practice,...
Dental Audits: the New Enigma?The Rise of Dental Audits (July 11, 2012): For many years, government fraud...
Returning a Medicaid Dental Overpayment: Part IIYesterday we discussed issues surrounding returning an identified dental overpayment...
Read More Posts From This CategoryMunicipal Law Articles
Peddling 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 ArbitrationIt 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 CategoryBusiness & Transaction Articles
A 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 ClaimsPersonal liability of individual owners of health care provider companies for claims... [Read more of this review]
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