Healthcare Law

Home Health Compliance Risks are a Significant Issue for Texas and Oklahoma Agencies

Home Health & Hospice /

(March 21, 2012): Over the past few weeks, several important events have occurred which should have home health agencies in Texas, Oklahoma and the rest of the country rethinking the adequacy of their existing compliance efforts. The home health compliance practices of many agencies have long been a concern of the Department of Health and […]

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OMHA Changes ALJ Hearing Case System

Medicare, Medicaid & Private Payor Updates /

(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

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Georgia Prepayment Reviews are Being Conducted by AdvanceMed

Medicare, Medicaid & Private Payor Updates /

(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,

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CMS Issues Proposed Rules About Returning Medicare Overpayments

Medicare, Medicaid & Private Payor Updates /

(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,

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Data Mining Tools Can Help Identify Possible Problems

Regulatory Issues | Privacy | Other /

(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

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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.

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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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“A Verbal Contract Isn’t Worth the Paper on Which it is Written.”

Regulatory Issues | Privacy | Other /

(November 21, 2011): After twenty years of practicing law, I still receive many calls from folks who have had a deal gone bad, money taken, partnerships that defrauded them, et cetera; of course, the first thing I ask is what did the contract say? The response I most often hear is, “there is no written

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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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