Search Results for: revocation

Home Health Revocation Actions by Medicare are Expanding Around the Country

Home Health & Hospice /

(September 28, 2020):Last September, CMS published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” [1] Among its many chan ges, the Final Rule significantly expanded the reasons that may be asserted by the Centers for Medicare and Medicaid Services (CMS) when revoking a health […]

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Medicare Revocation Actions Related to Telemedicine Rising!

Medicare, Medicaid & Private Payor Updates /

(September 25, 2020):  In recent years, many individuals (especially younger members of our work force) have embraced the chance to supplement their income through short-term engagements in the “gig economy.”  Notably, both professionals and non-professionals alike have found flexible, part-time opportunities online, allowing them to work remotely as independent contractors.  A number of physicians, nurse

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Responding to a Medicare Revocation Action Effective Prior to November 4, 2019

Medicare, Medicaid & Private Payor Updates /

(UPDATE: March 9, 2020): A Medicare revocation action can destroy the financial viability of your practice. Moreover, effective November 4, 2019, the reasons for which a health care provider or supplier may have its Medicare billing privileges revoked have greatly expanded. Our article titled “42 CFR Sec. 424.535(a) Medicare Revocation Actions — Your Medicare Billing

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42 CFR Sec. 424.535(a) Medicare Revocation Actions — Your Medicare Billing Privileges Can be Revoked For a Host of New Reasons. Are You Facing a Medicare Revocation Action? If so, You Must Act Fast to Preserve Your Appeal Rights.

Medicare, Medicaid & Private Payor Updates /

(March 9, 2020): Last September, the Centers for Medicare and Medicaid Services (CMS) published a Final Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process.” The Final Rule under 42 CFR Sec. 424.535(a) was published in order to implement sections 1866(j)(5) and 1902(kk)(3) of the Social Security

42 CFR Sec. 424.535(a) Medicare Revocation Actions — Your Medicare Billing Privileges Can be Revoked For a Host of New Reasons. Are You Facing a Medicare Revocation Action? If so, You Must Act Fast to Preserve Your Appeal Rights. Read More »

Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded.  What Steps are You Taking to Reduce Your Level of Risk?

Medicare, Medicaid & Private Payor Updates /

Big Changes to CMS Form 855 are on the Horizon[/caption] (September 18, 2019): On September 10, 2019, the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) published a Final Rule in the Federal Register entitled, “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider

Medicare, Medicaid and CHIP Enrollment Revocation and Denial Authorities Have Expanded.  What Steps are You Taking to Reduce Your Level of Risk? Read More »

Revocation of Your Medicare Billing Privileges

Medicare, Medicaid & Private Payor Updates /

(December 14, 2017): The Centers for Medicare and Medicaid Services (CMS) has engaged various types of outside contracting entities to perform program integrity functions on behalf of the Medicare program. At the present time, Uniform Program Integrity Contractors (UPICs) and Zone Program Integrity Contractors (ZPICs) are very aggressive when it comes to referring evidence of

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Medicare Revocation Action: Steps for Avoiding and Appealing

Medicare, Medicaid & Private Payor Updates /

(September 16, 2014): Consider the following scenario. You own a durable medical equipment (DME) company that you run out of a leased location in a local office building. Your customers are a mix of privately insured and Medicare/Medicaid beneficiaries. You’ve been in business for about 10 years, but money is tight and you need to

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Agencies Around the Country are Facing Expanded Administrative Medicare Hospice Audits and Investigations - Liles Parker

Agencies Around the Country are Facing Expanded Administrative Medicare Hospice Audits and Investigations

Home Health & Hospice /

(November 5, 2024): It’s been a frustrating year for many Medicare hospice providers around the country. Throughout 2024, hospice agencies have been under the focused scrutiny of both program integrity[1] and administrative claims processing[2] contractors working for the Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS). Unfortunately, the government’s

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Audits of Semaglutide and Other GLP-1 Claims are Increasing

Prescriber Risks Ordering Semaglutide, Tirzepatide and Other Compounded GLP-1 Medications

Regulatory Issues | Privacy | Other /

(October 24, 2024): Semaglutide, tirzepatide and a slate of other GLP-1 receptor agonist medications have dominated weight loss headlines in recent years. Not surprisingly, many weight loss providers and clinics have refocused their approaches, incorporating these drugs into patient treatment regimens. Unfortunately, the popularity of these drugs has led to a variety of bad practices,

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Ketamine Audits and Investigations are on the Rise - Featured Image

Ketamine Audits and Investigations are on the Rise! Are Your Ketamine Infusion / Injection Practices Compliant with the Law?

Medicare, Medicaid & Private Payor Updates /

(October 10, 2024): Ketamine has been in the news again lately. . . for all the wrong reasons. In August 2024, Federal prosecutors out of the Central District of California announced the indictment of five individuals, including two physicians, who allegedly played a role in the fatal ketamine overdose of Matthew Perry in October 2023.

Ketamine Audits and Investigations are on the Rise! Are Your Ketamine Infusion / Injection Practices Compliant with the Law? Read More »