"Nationwide Healthcare Lawyers"
(November 23, 2016): The Office of Audit Services, Office of Inspector General (OAS), is in the process of conducting audits of large home health agencies. These audits are being conducted, in part, because the Centers for Medicare and Medicaid Services (CMS) had determined through the Comprehensive Error Rate Testing Program (CERT) that for 2014, there […]
Responding to OIG Home Health Audits Read More »
(November 23, 2016): Michael Cook, co-chair of the Health Care Group, has an article published in the October issue of the American Health Lawyers Association Journal of Health Law & Life Sciences entitled “It’s Time for CMS and Congress to Review Outdated Medicare and Medicaid Provisions.” The article discusses the fact that given the dramatic
It’s Time for CMS and Congress to Review Outdated Medicare and Medicaid Provisions Read More »
(July 18, 2016): The Centers for Medicare and Medicaid Services (CMS) has announced a series of proposed changes to the Medicare claims appeal process. The new rules primarily impact the Administrative Law Judge (ALJ) level of review, and CMS has indicated that the purpose of these changes is to help reduce the backlog of pending
CMS Seeks to Overhaul Medicare Claims Appeal Process Read More »
(July 5, 2016) The Centers for Medicare and Medicaid Services (CMS) has announced a home health pre-claim review demonstration project to be initiated in five states. According to CMS, the purpose of the new project is to prevent improper Medicare payments, enhance quality of care, and deter waste, fraud, and abuse in the Medicare program.
CMS Announces Home Health Pre-Claim Review Demonstration Project for Five States Read More »
(April 4, 2016) In an effort to reduce the enormous backlog of pending Administrative Law Judge (ALJ) appeals, the Centers for Medicare and Medicaid Services (CMS) recently announced that it has expanded the pilot Settlement Conference Facilitation (SCF) process to include Part A claims. This process, which was previously only available to providers with pending
CMS Expands ALJ Appeal Claim Settlement Process to Include Part A Providers Read More »
(March 29, 2016) Lincare, Inc., a provider of respiratory care, infusion therapy and medical equipment to in-home patients, will pay $239,800 in Civil Money Penalties (CMPs) for violating the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule after a HHS Administrative Law Judge (ALJ) ruled in favor of the Office for Civil Rights (OCR).
Home Health HIPAA Violation Costs $239,800! Read More »
(January 12, 2016): With the advent of the Affordable Care Act and the changes in the payment incentives that are being developed by payors, including the Medicare and Medicaid programs, many emerging companies are developing new products and devices for the market. While companies will take these products through the regulatory process of obtaining FDA
Coverage and Payment of New Products – CPT / HCPCS Code Issues Read More »
(January 12, 2016): In our previous article on this subject, we discussed the new Comprehensive Joint Replacement program (CJR program) that CMS has initiated. Under that program, Medicare will pay approximately 800 hospitals in 67 MSAs a bundled payment to cover the costs of virtually all the care that is related to the treatment of
Providers, Hospitals, and the CJR Program – What You Need To Know! Read More »
(January 5, 2016): Now that you have appointed an individual to be responsible for the compliance program and created a compliance committee to help the compliance officer, the focus should turn to basic compliance policies and procedures. If an effective compliance program is like a house with a solid roof to protect the inhabitants from
Basic Compliance Policies and Procedures Read More »
(December 22, 2015): The number of durable medical equipment (DME) audits conducted by Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) have surged in recent years. Medicare contractors have gradually increased their scrutiny of DME suppliers’ claims. This has resulted in increased postpayment audits of DME suppliers’ claims and associated overpayment demands made
DME Audits are Back! Are Your Claims Compliant? Read More »