"Nationwide Healthcare Lawyers"
(August 23, 2016): The home health pre-claim review demonstration project has now started and will be in place for at least the next three years. How did we get to this point? Unfortunately, this demonstration project was initiated (in large part) based on the fact that improper payment rate for home health claims has gone […]
Home Health Pre-Claim Reviews Are Here! Read More »
(March 31, 2016): Many of the dental practices around the country do not participate in the Medicaid program and only a small number of dental practices provide services that might qualify for coverage under Medicare. Notably, the fact that most dental practices only accept cash or a handful of private payor plans significantly reduces their
Exclusion Screening / OIG Screening and Background Checks in Dental Practices Read More »
(March 16, 2016): Last week, the Centers for Medicare & Medicaid Services (CMS) released a new dataset which provides detailed information on services provided by skilled nursing facilities (SNFs) to Medicare beneficiaries. This data set is known as the “Skilled Nursing Facility Utilization and Payment Public Use File” (SNF PUF), as is part of CMS’s
Texas SNFs — Medicare Audits of Ultra High Therapy Claims are Here! Read More »
(October 27, 2015): Over the past year, Medicare fraud enforcement efforts throughout Texas have resulted in multiple convictions. These increased enforcement efforts should serve as a reminder to all Texas health care providers and suppliers that full compliance with applicable statutory and regulatory requirements is not an option — it is a necessity. I. Medicare
Medicare Fraud Enforcement Efforts Are Rising in Texas Read More »
(October 27, 2015): Late this summer, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) announced that more than $2 million in payments to dental providers for hospital outpatient dental services would have to be reimbursed to the federal government for failure to comply with Medicare program requirements. The
OIG Finds Significant Medicare Dental Overpayments Made to Hospitals Read More »
(October 26, 2015): Last month, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) released a study entitled “Questionable Billing for Medicare Ophthalmology Services.” As the study findings reflect, the OIG concluded that for the year 2012, approximately $171 million of the Medicare payments made that year for ophthalmology services were
Medicare Ophthalmology Audits: Is Your Practice Ready? Read More »
(October 20, 2015): As required by the Small Business Jobs Act of 2010, the Department of Health and Human Services (HHS) is required to conduct a review of payments for Medicare fee-for-service claims by using “predictive analytics technologies” every three years. Predictive analytics technologies employ a variety of predictive models and statistical analysts for detection
ZPIC Use of the Medicare Fraud Prevention System Read More »
(May 5, 2015): As the health care providers and suppliers we represent can easily attest, there are serious problems plaguing the current Medicare appeals process. Rubber-stamp denials by contractors[1] at lower levels of appeal, the failure of Medicare contractors to apply the correct coverage rules and requirements when assessing a claim, and lengthy delays in
The Medicare Appeals Process is Broken Read More »
(April 22, 2015): Late last month, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) released its 2015 “Compendium of Unimplemented Recommendations” (Compendium). Published annually, the Compendium sets out the top 25 program integrity issues previously identified by HHS-OIG that are expected to “most positively impact HHS programs in terms of cost
Are More Home Health Program Integrity Initiatives on the Horizon? Read More »
(April 3, 2015): Starting this year, eligible providers who have not attested to meaningful use of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for 2014 will face a 1% penalty on Medicare reimbursement. The penalties will increase to 2% in 2016 and 3% in 2017. Depending on the total number of Medicare eligible
Responding to a EHR Meaningful Use Audit Read More »