Medicare, Medicaid & Private Payor Updates

CERT Postpayment Audits: An Overview of the Audit Process

Medicare, Medicaid & Private Payor Updates /

(March 12, 2011): Health care providers around the country are finding their practices and clinics subjected to Medicare post-payment audits by Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Comprehensive Error Rate Testing (CERT) Contractors. While all post-payment audits should be taken seriously, there are real differences between both the contractors and the […]

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Texas Providers Should Expect Increase in Postpayment Audits of E/M Claims.

Medicare, Medicaid & Private Payor Updates /

(March 8, 2011): In February 2011, TrailBlazer Health Enterprises (TrailBlazer) reported the results of “widespread ” probe reviews the contractor conducted of CPT Codes 99211–99215 related to Evaluation and Management (E/M) claims billed for dates of service 01/01/10 through 06/30/10. The frequency of E/M audits directed at Texas Medicare providers are increasing. Is your practice

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Are Medicare ALJs Truly Independent Fact Finders?

Medicare, Medicaid & Private Payor Updates /

(February 20, 2011): Over the years, we have represented a wide variety of health care providers in the administrative appeals process. Our duties have regularly included representation before Administrative Law Judges (ALJs) presiding out of the Western, Southern, Midwestern and Mid-Atlantic Field Offices of the Office of Medicare Hearings and Appeals. (OMHA). In the course

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ZPICs Will Deny Claims with “Signature Stamps” and “Date Stamps”

Medicare, Medicaid & Private Payor Updates /

(February 19, 2011): While the use of “signature stamps” has been prohibited for quite some time, a wide variety of health care providers have continued to use “date stamps” or some other method of memorializing when a document was signed by an ordering or treating physician. While the Centers for Medicare and Medicaid Services (CMS)

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ZPIC Participation in ALJ Hearings is Increasing

Medicare, Medicaid & Private Payor Updates /

(February 12, 2011): Over the last year, we have noted an important trend when representing Medicare providers in post-payment overpayment cases at the Administrative Law Judge (ALJ) level of appeal. Medicare contractors are actively attending and participating in many ALJ hearings. In fact, it is now common for a Zone Program Integrity Contractor (ZPIC) to

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2011: The Year of Compliance – Medicare Payment Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 26, 2011): Medicare payment suspension action can prove disastrous for your practice or home health agency. How did we get to this point? The recent debate over healthcare in this country has drawn attention to healthcare costs as well as the relationship between healthcare providers and the Federal government. With healthcare costs steadily on

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2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 11, 2011): ZPIC audits and ZPIC suspension actions are a serious risk facing non-hospital providers today. As you recall at the end of 2010 we identified the “Top Ten Health Care Compliance Risks for 2011”. The purpose of this article is to analyze two of those risks; Zone Program Integrity Contractor (ZPIC) audits and

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Top Ten Health Care Compliance Risks for 2011

Medicare, Medicaid & Private Payor Updates /

(December 31, 2010): In case you missed it, Congress, President Obama and the healthcare regulators had a banner year with respect to regulatory activism in 2010. Over the next several weeks we will be releasing a series of articles on our website addressing the compliance risk areas facing your organise dramatic changes and the compliance

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Keeping an Eye on the Medicare AdQIC

Medicare, Medicaid & Private Payor Updates /

(May 16, 2023): The Medicare program is enormous. The Centers for Medicare & Medicaid Services (CMS) estimates that Medicare Administrative Contractors (MAC) process 1.2 billion[1] fee-for-service claims each year in connection with the original[2] (or traditional) Medicare program. If you have ever been involved in a Medicare postpayment audit (or even a prepayment audit[3]) where

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Virginia Judge Concludes That Health Care Reform Law is Unconstitutional

Medicare, Medicaid & Private Payor Updates /

(December 13, 2010):  A Federal Judge for the Eastern District of Virginia concluded that the provision of the recent Health Reform Law may be unconstitutional.  that penalizes/taxes individuals who fail to purchase health insurance, violates the United States Constitution.  In doing so, the Court reaches a different conclusion than two other Federal courts – one

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