"Nationwide Healthcare Lawyers"
(March 2, 2012): Likely recognizing the enormous disparity in Administrative Law Judge (ALJ) hearing workloads for its various Field Offices, the Office of Medicare Hearings and Appeals (OMHA) recently switched to a Central Docketing System for all pending and new appeals. Under this new system, all ALJ hearing requests will be sent to OMHA’s Central […]
OMHA Changes ALJ Hearing Case System Read More »
(February 29, 2012): In the past few weeks, AdvanceMed Corporation, the Zone Program Integrity Contractor (ZPIC) for Regions II and V (covering the Northwestern and Southeastern portions of the United States, respectively), appears to have significantly expanded the number of Georgia prepayment reviews it is conducting. More specifically, AdvanceMed appears to be focusing on hospices,
Georgia Prepayment Reviews are Being Conducted by AdvanceMed Read More »
(February 22, 2012): The proper handling of Medicare overpayments is an essential responsibility of all participating providers. Late last week, the Centers for Medicare & Medicaid Services (CMS) released an important proposed rule in the Federal Register that could dramatically affect all healthcare providers, Third-party billers and other entities involved in the healthcare industry. The proposed rule,
CMS Issues Proposed Rules About Returning Medicare Overpayments Read More »
(February 8, 2012): While we all know that many Medicare post-payment audits are often generated as a result of sophisticated data mining analyses, the particular elements of concern which may give rise to a specific provider audit are not always so clear. Health care providers interested in compliance can use data mining assessment tools to
Data Mining Tools Can Help Identify Possible Problems Read More »
(February 7, 2012): In recent years, physicians and other health care providers have faced a wide number of administrative actions and sanctions levied by contractors working for the Centers for Medicare and Medicaid Services (CMS). Zone Program Integrity Contractors (ZPICs) have subjected physician practices to Medicare prepayment reviews, postpayment audits, suspension and / or revocation
RAC-Initiated Medicare Prepayment Reviews Will Soon Begin. Read More »
(January 25, 2012): Historically, home health agencies, physicians, clinics and other health care providers have associated the term “whistleblower” with the filing of a FalSe Claims Act case by an insider, former employee or other individual alleging to have direct knowledge of fraudulent billing conduct by a provider. As health care providers will soon find,
Are HIPAA Whistleblower Provisions Around the Corner? Read More »
(January 20, 2012): The Department of Health and Human Services (HHS) has long used reports and complaints from affected patients to further conduct Medicare audits of possible Medicare fraud, waste and abuse. Last June, it was reported that HHS was planning on implementing a “Mystery Shopper” program, with a Federal contractor posing as a potential
The Senior Medicare Patrol is Here! Read More »
Liles Parker’s Washington D.C. office has moved. Effective 2016, our new DC Office address: Liles Parker, PLLC 2121 Wisconsin Ave. NW Suite 200Washington, DC. 20007 Our phone number, fax number and email addresses remain the same. We look forward to assisting you with health law matters, including ZPIC and RAC overpayment appeals, compliance programs
Liles Parker has moved its DC Office. Read More »
(December 19, 2011): As you know, RACs play an important role in the identification of Part A and Part B overpayments. Since the inception of the RAC Demonstration Project in 2005, RACs have successfully identified a number of improper claims, denying payment for reasons ranging from mere technical errors to broad concerns about medical necessity.
Is a RAC Prepayment Review of Your Medicare Claims on the Horizon? Read More »
(November 23, 2011): The “Comprehensive Error Rate Testing” (CERT) program was implemented as a mechanism for the Centers for Medicare and Medicaid Services (CMS) to assess whether their Medicare Administrative Contractors (MACs) are properly paying claims. In other words, is a particular MAC failing to identify and deny improper claims? Alternatively, is the MAC denying
A CERT Audit Is Serious – Don’t Take These Medicare Reviews Lightly Read More »
You must be logged in to post a comment.