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(June 21, 2011): Last week, Texas Governor Rick Perry signed legislation aimed at bringing modest reform to the rules governing investigations of physicians by the Texas Medical Board. The Texas Medical Board is the state’s regulatory body that licenses and disciplines physicians and other health care professionals. House Bill 680 — HB 680, which takes […]
Texas Physicians and the Texas Medical Board Under HB 680 Read More »
(June 18, 2011): As a review of the last several quarters of Medicare appeals statistics reflects, an overwhelming percentage of Medicare providers appealing alleged overpayments through the Medicare administrative appeals process have chosen to “throw in the towel,” so to speak, when they have lost at the reconsideration level. As you will recall, at the
Lose Your Appeal at Reconsideration? Consider an ALJ Hearing Read More »
(May 24, 2011): On May 6, CMS proposed to amend its rules governing the adequacy of provider Medicaid payment rates. This proposed rule, may be the most important regulatory action to protect providers and beneficiaries from draconian rate reductions since the repeal of the Federal standard known as the Boren amendment, in 1997. Currently, Federal
Proposed Medicaid Payment Rates are a Potential Game Changer Read More »
(April 15, 2011): Over the last decade, the Centers for Medicare and Medicaid Services (CMS) and its contractors (Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Recovery Audit Contractors (RACs)), have steadily assembled an extensive database of the coding and billing practices of Medicare providers around the country. Analyzing this data, contractors have
Predictive Modeling: ZPICs Using Data Mining to Identify Medicare Fraud Read More »
(April 10, 2011): Last week, it was announced that NCI, Inc., one of the nation’s most successful information technology companies had acquired the outstanding capital stock of AdvanceMed Corporation (AdvanceMed), an affiliate of CSC. While the acquisition went largely unnoticed by the health care provider community, the transaction may, in fact, be quite significant. With
NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5. Read More »
(April 6, 2011): On September 15, 2010, the Inspector General of the Department of Health and Human Services (HHS-OIG), Daniel Levinson, testified before the House Committee on Energy and Commerce, Subcommittee on Health regarding waste, fraud, and abuse in the Medicare program, with a specific focus on durable medical equipment and supplies. Mr. Levinson noted
ZPIC Audits are Here. When it Rains, it Pours . . . DME Compliance is Essential! Read More »
(April 1, 2011): Skilled Nursing Facilities (SNFs) are again in the spotlight. A recent report likely signals an increase in future SNF Audits. The Prospective Payment System (PPS) under which SNFs are reimbursed by Medicare has long been criticized by many concerned with “benefit integrity” and curbing waste, fraud, and abuse in the Medicare program.
HHS-OIG Report Signals an Increase in SNF Audits by ZPICs Read More »
(March 25, 2011): Zone Program Integrity Contractors (ZPICs) have established themselves as the preeminent audit tool of the Centers for Medicare and Medicaid Services (CMS), surpassing both Recovery Audit Contractors (RACs) and Medicare Administrative Contractor (MAC) Benefit Integrity units. Unfortunately, many health care providers and suppliers wait until notice of an audit has been received
The Medicare Administrative Appeal Process Read More »
(March 12, 2011): Health care providers around the country are finding their practices and clinics subjected to Medicare post-payment audits by Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Comprehensive Error Rate Testing (CERT) Contractors. While all post-payment audits should be taken seriously, there are real differences between both the contractors and the
CERT Postpayment Audits: An Overview of the Audit Process Read More »
(March 8, 2011): In February 2011, TrailBlazer Health Enterprises (TrailBlazer) reported the results of “widespread ” probe reviews the contractor conducted of CPT Codes 99211–99215 related to Evaluation and Management (E/M) claims billed for dates of service 01/01/10 through 06/30/10. The frequency of E/M audits directed at Texas Medicare providers are increasing. Is your practice
Texas Providers Should Expect Increase in Postpayment Audits of E/M Claims. Read More »