Medicare, Medicaid & Private Payor Updates

Strategic Health Solutions is Merely the Latest CMS Contractor to Flex its Audit Muscles

Medicare, Medicaid & Private Payor Updates /

(May 9, 2013): Strategic Health Solutions is an Omaha, Nebraska-based company that provides professional health care education and audit services for both federal and state government agencies. In recent months, a wide range of physicians (working in specialty areas ranging from endocrinology to pain management) have received audit letters asking for supporting documentation associated with […]

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Recovery Audit Contractor Changes will be Major in 2014

Medicare, Medicaid & Private Payor Updates /

(May 7, 2013): The Recovery Audit Contractor (RAC) program is slated to undergo significant changes in 2014. As discussed below, non-hospital health care providers and suppliers are likely to find the Medicare appeals process more complex than ever as RACs enter into the process in an effort to defend their denial decisions. I. Background of

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Does One of Your Employees Suffer from a Chronic Illness or Medical Condition? Consider the ADA When Assessing Their Request for Additional Medical Leave

Medicare, Medicaid & Private Payor Updates /

(March 19, 2013): It’s a fact of life – essentially all us will likely fall ill or develop a chronic medical condition at some point during our employment. Employees working in physician offices, home health agencies and for Durable Medical Equipment (DME) suppliers are no exception. When this occurs, owners and managers cannot forget their

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PERM Audits of Medicaid, Managed Care and CHIP Claims are Ongoing. Are You Prepared to Respond to a PERM Audit?

Medicare, Medicaid & Private Payor Updates /

Author: Ashley Morgan, Annabella Denzel (September 28, 2023): Providers participating in the Medicare and Medicaid programs are currently subject to audit by numerous Federal and State regulatory and law enforcement agencies. Additionally, the Centers for Medicare and Medicaid Services (CMS) has entered several contractual arrangements with private contractors to handle various aspects of administrative integrity

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A TMB Complaint is Serious Business — Don’t Take the Texas Medical Board Complaint Process Lightly

Medicare, Medicaid & Private Payor Updates /

(February 10, 2013): Texas physicians face a myriad of challenges each and every day. In an era when reimbursement rates are declining yet many expenses are continuing to rise, physicians are also seeing many of their services co-opted by physician assistants and nurse practitioners, thereby further increasing competitive pressures. Unfortunately, these challenges only represent the

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The Texas Medical Board Remains Busy Due to High Number of Complaints Filed in 2012

Medicare, Medicaid & Private Payor Updates /

(February 7, 2013): The Texas Medical Board (Medical Board) was quite busy in 2012. While the number of disciplinary action taken had dropped in some categories, it rose in others. In fact, the overall number of complaints filed with the Medical Board was the 2nd highest in the last decade. The Medical Board’s workload numbers

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Texas Licensing Boards Have Announced a Pain Clinic Takedown and Have Disciplined Multiple MDs and PAs

Medicare, Medicaid & Private Payor Updates /

(February 5, 2013): In late December 2012, the Texas Medical Board and the Texas Physician Assistant Board announced that they had suspended or restricted the licenses of seventeen physicians and four physician assistants as part of coordinated “Pain Clinic Takedown.” These licensing Boards met over a two-week period in back-to-back disciplinary hearings last December and

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DME Claims Audits of Back Braces by OIG, MACs, and ZPICs are Likely to Further Intensify

Medicare, Medicaid & Private Payor Updates /

(February 5, 2013): A “back orthosis” is type of brace that is placed on the outside of a patient’s body and is intended to help stabilize a patient’s spine. In some instances, it is used to limit motion. In others, it is used to address a structural deformity which may exist (such as scoliosis). There

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Medicare Exclusion Screening is Essential to Compliance – Failure to Properly Screen Can be Costly

Medicare, Medicaid & Private Payor Updates /

(January 14, 2013): In recent years, we have represented physicians and a range of other health care providers in administrative litigation over “exclusion” related enforcement actions. One of the most severe sanctions available under the Social Security Act stems from the authority to exclude individuals and entities from participation in federal health care programs. Medicare

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The Recovery Audit Contractor Program Continues to Expand its Medicare Footprint

Medicare, Medicaid & Private Payor Updates /

(November 26, 2012): The Medicare Fee-for-Service (FFS) program consists of numerous payment systems, with a complex network of contractors that process more than one billion claims submitted by more than one million healthcare providers each year.[1] Medicare providers include hospitals, physicians, skilled nursing facilities, labs, ambulance companies, and durable medical equipment, prosthetics, orthotics, and supplies

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