Medicare, Medicaid & Private Payor Updates

Options for Responding if Your Practice is Placed on ZPIC Prepayment Review

Medicare, Medicaid & Private Payor Updates /

(September 3, 2012): Zone Program Integrity Contractors (ZPICs) have turned much of their attention to prepayment review, the process by which the Medicare contractor reviews a claim for problems before it is paid. Unlike postpayment review, ZPIC prepayment review does not have an administrative appeals process, making these types of reviews incredibly damaging for a […]

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Medicare Audits in Miami, FL

Medicare, Medicaid & Private Payor Updates /

(August 28, 2012): In this feature, we focus on particular Medicare audits and appeals information for various ZPIC audit and RAC audit hotspots around the country. Check back in for information about Medicare audits and appeals in your city. Medicare Audits in Miami, FL: At-a-Glance Information: Miami Population: 408,750 (2011 Census)Medicare Administrative Contractor (MAC) (Parts

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Medicare Administrative Appeals Process – An Overview for New Providers

Medicare, Medicaid & Private Payor Updates /

(August 15, 2012): Is this your first time being audited by a Medicare Administrative Contractor (MAC) or a Zone Program Integrity Contractor (ZPIC)? If so, the brief outline below can provide a handy summary of the Medicare appeals process. I. Step 1 – Request for Information: In most instances, a health care provider will receive

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Baton Rouge Medicare Audits by CMS Program Integrity Contractors.

Medicare, Medicaid & Private Payor Updates /

(July 30, 2012): Baton Rouge Medicare audits are on the rise. Here’s a summary of the Medicare contractors who service the healthcare providers and suppliers in Baton Rouse, LA: Baton Rouge Population: 230,139 (2011 Census) Medicare Administrative Contractor (MAC) (Parts A/B): Novitas Solutions LLC (a/k/a Highmark) DME MAC (Region C): CIGNA Government Services Administrators LLC

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Houston Medicare Audits and Enforcement Actions.

Medicare, Medicaid & Private Payor Updates /

(July 20, 2012): The number of Medicare audits in Houston, TX, by “Health Integrity,” the Zone Program Integrity Contractors (ZPIC) assigned to this geographic region is steadily increasing each year. An overview of the Houston, TX, contractors assigned to provide support for Medicare health care providers and suppliers is set out below: Houston Population: 2,145,146

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Choosing the Right ZPIC Audit Appeals Attorney: Who is Best for You?

Medicare, Medicaid & Private Payor Updates /

(July 19, 2012): Choosing the right ZPIC audit appeals attorney to represent your practice is possibly the most important step you can take to protecting your rights during the ZPIC audit and appeals process. Indeed, who your representative is in ZPIC cases can make all the difference in the world. It is not enough to

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Medicare Administrative Contractor Changes — MAC Changes and Update.

Medicare, Medicaid & Private Payor Updates /

(July 5, 2012): Recently, the Centers for Medicare & Medicaid Services (CMS) has done some realignment of its Medicare Administrative Contractor (MAC or AC) jurisdictions for Medicare Parts A and B. In addition, it has actively sought proposals through a competitive bidding process to get the most cost-effective contractors processing Medicare claims. Because of all

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Supreme Court Rules That the ACA is Constitutional

Medicare, Medicaid & Private Payor Updates /

(June 28, 2012): In a landmark case for the healthcare industry, the Supreme Court ruled today that the “individual mandate” provisions of the Affordable Care Act (ACA), colloquially known as “Obamacare,” were indeed constitutional. As such, ACA was largely upheld by the Court. This decision further expands Congress’ legislative powers and maintains some of the

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Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers

Medicare, Medicaid & Private Payor Updates /

(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were

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Social Media and Healthcare: A Little More Complicated

Medicare, Medicaid & Private Payor Updates /

(June 20, 2012): A few weeks ago, you may have heard our Firm present a webinar on “Healthcare Providers and Social Media: Risks to be Considered.” Our article here summarizes some of the more important points of that presentation. As an update, we are detailing some new issues to be taken into account by providers

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