CMS

CMS Announces Home Health Pre-Claim Review Demonstration Project for Five States

Home Health & Hospice /

(July 5, 2016) The Centers for Medicare and Medicaid Services (CMS) has announced a home health pre-claim review demonstration project to be initiated in five states. According to CMS, the purpose of the new project is to prevent improper Medicare payments, enhance quality of care, and deter waste, fraud, and abuse in the Medicare program. […]

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Medicare’s Home Health Probe and Educate Program is Underway

Home Health & Hospice /

(December 4, 2015): The Centers for Medicare and Medicaid Services (CMS) has directed its contractors to initiate a home health probe and educate program review process with home health agencies around the country. The focus of this program will be to assess agencies’ compliance with the new face-to-face (F2F) documentation requirements that became effective 01/01/15.

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CMS Awards Zone 6 ZPIC Contract to SafeGuard Services

Medicare, Medicaid & Private Payor Updates /

(August 15, 2015): The Centers for Medicare and Medicaid Services (CMS) has awarded the contract for Zone Program Integrity Contractor (ZPIC) services for Zone 6 to SafeGuard Services, LLC. Zone 6 encompasses Maryland, Delaware, Washington, D.C., Pennsylvania, New Jersey, New York, Connecticut, Massachusetts, Rhode Island, Vermont, New Hampshire, and Maine. SafeGuard is the current program

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The FY 2016 Budget Proposes Medicare Appeals Process Reforms

Medicare, Medicaid & Private Payor Updates /

(February 27, 2015): On February 2, 2015, President Obama released his fiscal year 2016 budget proposal. This latest proposal affects a significant number of Federal health care programs and includes over $1 trillion allocated to the U.S. Department of Health and Human Services (HHS). More than 85 percent of HHS’s budget is devoted to programs

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CMS Implements RAC Program Improvements

Medicare, Medicaid & Private Payor Updates /

(January 9th, 2015) Health care providers increasingly complain that the Recovery Audit Program creates numerous administrative and financial burdens for those participating in the federal Medicare program. Providers continue to advocate for numerous changes to the program, especially those that will reduce their burden when dealing with Recovery Audit Contractors (RACs). In response to these

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CMS Extends HHA Enrollment Moratoria

Medicare, Medicaid & Private Payor Updates /

(August 6, 2014): The Centers for Medicare & Medicaid Services (CMS) has extended its year-long HHA enrollment moratoria on the enrollment of new home health agencies and ground ambulance suppliers in several major metropolitan areas. Furthermore, CMS has broadened its temporary enrollment moratoria so that it applies not only to Medicare, but also to enrollment

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Miscoded Evaluation and Management Services Cost Medicare $6.7 Billion

Medicare, Medicaid & Private Payor Updates /

(June 25, 2014) Officials at the Department of Health and Human Services, Office of Inspector General (OIG) recently examined medical records from 2010 for claims related to evaluation and management services (E/M services). The results are astounding. OIG determined that Medicare inappropriately paid $6.7 BILLION for E/M services that year due to claims that were

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CMS and Contractors Must Address EHR Fraud Vulnerabilities

Medicare, Medicaid & Private Payor Updates /

(February 7, 2014): A new report from the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) finds that the Centers for Medicare and Medicaid Services (CMS) and its contractors have adopted few Medicare program integrity practices to address electronic health record (EHR) fraud vulnerabilities. These EHR fraud vulnerabilities include

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Improper Medicare Payments Are Still Being Made for Deceased Beneficiaries

Medicare, Medicaid & Private Payor Updates /

(November 20, 2013): While most health care providers and suppliers are diligent in their efforts to ensure that Medicare services are submitted appropriately, mistakes and other improper billings still take place. Two areas of continuing concern involve providers and / or suppliers who submit fraudulent claims to Medicare seeking reimbursement on behalf of deceased beneficiaries

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Are HIPAA Whistleblower Provisions Around the Corner?

Medicare, Medicaid & Private Payor Updates /

(January 25, 2012): Historically, home health agencies, physicians, clinics and other health care providers have associated the term “whistleblower” with the filing of a FalSe Claims Act case by an insider, former employee or other individual alleging to have direct knowledge of fraudulent billing conduct by a provider. As health care providers will soon find,

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