Medicare, Medicaid & Private Payor Updates

RAC-Initiated Medicare Prepayment Reviews Will Soon Begin.

Medicare, Medicaid & Private Payor Updates /

(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 »

Are HIPAA Whistleblower Provisions Around the Corner?

Medicare, Medicaid & Private Payor Updates /

(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,

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Is a RAC Prepayment Review of Your Medicare Claims on the Horizon?

Medicare, Medicaid & Private Payor Updates /

(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 »

A CERT Audit Is Serious – Don’t Take These Medicare Reviews Lightly

Medicare, Medicaid & Private Payor Updates /

(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

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Data Mining is Being Used for ZPICs Targeting Purposes

Medicare, Medicaid & Private Payor Updates /

(November 16, 2011): Many providers believe that their practice is a normal one – average billings, average patient load, costs of care which are consistent with industry standards – and that they need not be concerned with undergoing a Medicare post payment audit for being a “statistical outlier.” As you may know, Medicare and Medicaid

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CMS’s New Physician Compare Website to Report on Provider Performance

Medicare, Medicaid & Private Payor Updates /

(November 15, 2011): Last year, the Centers for Medicare and Medicaid Services (CMS) launched their Physician Compare website. CMS’s Physician Compare website allows beneficiaries to research their health care providers. The Affordable Care Act (commonly referred to as “Health Care Reform”) mandated that CMS launch such a website and that it implement physician performance metrics

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Conducting a Gap Analysis / Mock Audit: An Essential Compliance Tool for Your Practice

Medicare, Medicaid & Private Payor Updates /

(November 15, 2011): Understandably, health care providers have grown weary of government audits, malpractice issues, peer reviews and private payor assessments. In an effort to reduce their potential liability, many providers are now regularly utilizing Gap Analyses / Mock Audits to test their preparedness for audit. In doing so, they have been able to identify

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Maryland Bullying, Cyber Bullying and Hazing Laws

Medicare, Medicaid & Private Payor Updates /

(October 25, 2011): As set out under Maryland law, “All students in Maryland’s public schools, without exception and regardless of race, ethnicity, region, religion, gender, sexual orientation, language, socioeconomic status, age, or disability, have the right to educational environments that are safe, appropriate for academic achievement, and free from any form of harassment.” I. Maryland

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Ten Recommendations to Improve Medicare Compliance and Prepare for a ZPIC Audit

Medicare, Medicaid & Private Payor Updates /

(July 24, 2011): Has your Texas physician practice, home health agency, hospice, DME company or PT / OT / ST clinic been audited by a Zone Program Integrity Program (ZPIC)? If not, it may only be a matter of time. Despite your best efforts to follow Medicare’s directives, your organization may still be identified as

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