"Nationwide Healthcare Lawyers"
(January 20, 2017): The Medicare appeals backlog has reached its all-time worst. If you’re a healthcare provider or supplier waiting for a hearing before an Administrative Law Judge (ALJ) at the Office of Medicare Hearings and Medicare Appeals (OMHA) – the third level of the Medicare appeals process – you’ve likely been waiting years to […]
HHS Issues Final Rule to Address Record High Medicare Appeals Backlog Read More »
(July 18, 2016): The Centers for Medicare and Medicaid Services (CMS) has announced a series of proposed changes to the Medicare claims appeal process. The new rules primarily impact the Administrative Law Judge (ALJ) level of review, and CMS has indicated that the purpose of these changes is to help reduce the backlog of pending
CMS Seeks to Overhaul Medicare Claims Appeal Process Read More »
(April 4, 2016) In an effort to reduce the enormous backlog of pending Administrative Law Judge (ALJ) appeals, the Centers for Medicare and Medicaid Services (CMS) recently announced that it has expanded the pilot Settlement Conference Facilitation (SCF) process to include Part A claims. This process, which was previously only available to providers with pending
CMS Expands ALJ Appeal Claim Settlement Process to Include Part A Providers 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 »
(January 12, 2016): With the advent of the Affordable Care Act and the changes in the payment incentives that are being developed by payors, including the Medicare and Medicaid programs, many emerging companies are developing new products and devices for the market. While companies will take these products through the regulatory process of obtaining FDA
Coverage and Payment of New Products – CPT / HCPCS Code Issues Read More »
(January 12, 2016): In our previous article on this subject, we discussed the new Comprehensive Joint Replacement program (CJR program) that CMS has initiated. Under that program, Medicare will pay approximately 800 hospitals in 67 MSAs a bundled payment to cover the costs of virtually all the care that is related to the treatment of
Providers, Hospitals, and the CJR Program – What You Need To Know! Read More »
(January 5, 2016): Now that you have appointed an individual to be responsible for the compliance program and created a compliance committee to help the compliance officer, the focus should turn to basic compliance policies and procedures. If an effective compliance program is like a house with a solid roof to protect the inhabitants from
Basic Compliance Policies and Procedures Read More »
(December 22, 2015): The number of durable medical equipment (DME) audits conducted by Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) have surged in recent years. Medicare contractors have gradually increased their scrutiny of DME suppliers’ claims. This has resulted in increased postpayment audits of DME suppliers’ claims and associated overpayment demands made
DME Audits are Back! Are Your Claims Compliant? Read More »
(December 8, 2015): Since the passage of the Patient Protection and Affordable Care Act of March 2010[1] (ACA) and progeny such as the HITECH Act [2], enforcement efforts have been better funded and consequently, better staffed. The enactment of HIPAA in 1996 [3] and the Balanced Budget Act (BBA) of 1997 [4], further expanded the
Exclusion Screening Enforcement Actions by OIG are Increasing. Read More »
(October 29, 2015): Last month we discussed why having a functioning, effective compliance program is important. If done correctly, a compliance program that is functional, effective, and well-documented is as important as your medical malpractice liability insurance. Indeed, the Affordable Care Act now requires compliance programs and many private payers now explicitly require compliance programs
Does Your Practice Have a Compliance Officer or Compliance Committee? Read More »