Search Results for: private overpayment

Dental Practice Audits are on the Rise — Protect your Interests!

Dental Audits & Compliance /

(October 11, 2016): More than 45 million children receive government-funded dental care served under Medicaid and CHIP programs. This equates to approximately 1 out every 3 children in the country. The dental care provided includes screening services and other preventive, diagnostic, and treatment services that are medically necessary and properly documented. Under the mandatory Early […]

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Webinars Playback

2020-2021 TAHCH Webinars   Wednesday, January 6th, 2020, 1 p.m. EST / Noon CST / 10:00 a.m. PST COVID-19 Employee Health Issues for Home Health Hospice Agencies Despite the approval, release and distribution of a coronavirus vaccine, the numbers of available doses are still not sufficient to vaccinate all at-risk populations and individuals.  Thus, home

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AMBA Webinars

AMBA Webinar Reading the Tea Leaves – What are the Top Risks Your Practice and / or Third-Party Billing Company will Face in 2025? Tuesday, January 14, 2025 12:00 NOON EST / 11:00 A.M. CST / 9:00 A.M. PST Duration: 60 Minutes Matthew Catoe JD, CPC, CMRS Robert Saltaformaggio JD, CMRS, CPC, CMCO Join us

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DME Audits are Back! Are Your Claims Compliant?

Medicare, Medicaid & Private Payor Updates /

(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

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ZPIC Use of the Medicare Fraud Prevention System

Medicare, Medicaid & Private Payor Updates /

(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

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Structural Denial of Due Process in HCQIA Peer Review Proceedings

Medicare, Medicaid & Private Payor Updates /

(October 12, 2015): The Federal HCQIA peer review statute affords peer-reviewing bodies and their members legal immunity from liability from suits by the physicians they discipline, so long as their peer-review processes include certain due process rights for the accused physician. These due process rights are expressed as a right to a hearing, and are

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The Medicare Appeals Process is Broken

Medicare, Medicaid & Private Payor Updates /

(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

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Dental Claims False Claims Act Liability

Dental Audits & Compliance /

(March 6, 2015): As we have seen in recent years, Medicaid audits resulting in dental claims False Claims Act liability are increasing around the country.  Earlier this week, the U.S. Attorney’s Office, the U.S. Department of Health and Human Services. Office of Inspector General (HHS-OIG), and the Maine Attorney General’s Office announced the settlement of

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