Medicare Lifts Ban on Coverage for Sex Reassignment Surgery
Medicare Lifts Ban on Medicare Coverage for Sex Change Surgery
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Medicare ALJ Appeals of Denied Home Health Claims
(February 11, 2014): Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims? If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process. Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative
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Is Your Dental Practice Prepared to Undergo a Medicaid Dental Audit?
(November 25, 2013): The link between oral health and overall health has been increasingly acknowledged over the years. Emphasis has been placed on children’s oral health in particular. In fact, the Children’s Health Insurance Program Re-authorization Act of 2009 (CHIPRA) mandates that “child health assistance provided to a targeted low-income child shall include coverage of
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Texas Medical Board Complaints are Serious Business!
(September 20, 2013): Like other physicians around the country, Texas physicians are currently facing increasing pressures to ensure that their medical necessity determinations, coverage assessments, documentation, coding and billing activities meet both Medicare’s requirements and those of private payors. While their duties and responsibilities have continued to increase, reimbursement rates have steadily fallen. Notably, Texas
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PERM Audits of Medicaid, Managed Care and CHIP Claims are Ongoing. Are You Prepared to Respond to a PERM Audit?
Author: Ashley Morgan, Annabella Denzel (September 28, 2023): Providers participating in the Medicare and Medicaid programs are currently subject to audit by numerous Federal and State regulatory and law enforcement agencies. Additionally, the Centers for Medicare and Medicaid Services (CMS) has entered several contractual arrangements with private contractors to handle various aspects of administrative integrity
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, peddling and soliciting within city limits. International Society for Krishna Consciousness, Inc. v. Lee, 505 U.S. 672, 112 S. Ct. 2711, 120 L. Ed. 2d 541 (1992). The public policy that allows cities to regulate peddlers or the solicitation of contributions is to
Personal Care Service Agencies and Personal Care Service Attendants are Increasingly Targeted in Medicaid Fraud Investigations
(September 15, 2023): Medicaid funding for personal care services allows those that need help for activities of daily living to remain in their homes and receive care from qualified individuals rather than have to live in institutional settings.[1] This is also a benefit to Medicaid, as it reduces the demand and costs for institutional and
The OIG Identifies Substantial SNF Medicare Overpayments
(November 18, 2012): A recent report issued by the Department of Health and Human Services, Office of Inspector General (OIG), OEI-02-09-00200 (Report), found substantial errors in payments made by Medicare to skilled nursing facilities (SNFs) for FY 2009. The Report also found substantial errors in SNF reporting on the Minimum Data Set (MDS) forms. Specifically,
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Liles Parker Says “Thank You” to America’s Veterans — God Bless America
(November 12, 2012): On this Veterans Day, Liles Parker thanks all of our nation’s veterans for their tremendous service and sacrifice in the defense of the United States of America. Please join us in remembering our soldiers, marines, sailors, and airmen for their unparalleled courage and commitment to our country. Liles Parker is a full service,
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Individual Liability for Medicare Overpayment Claims
(October 19, 2012): This article addresses the case where an individual or “natural person” owns an interest in a Medicare health care provider which is incorporated[1] under the laws of a state, as a corporation, limited liability company, limited partnership, or another type of legal person. The individual may be a shareholder, member, limited partner,
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