CMS

CMS’s New Physician Compare Website to Report on Provider Performance

Medicare, Medicaid & Private Payor Updates /

(November 15, 2011): Last year, the Centers for Medicare and Medicaid Services (CMS) launched their Physician Compare website. CMS’s Physician Compare website allows beneficiaries to research their health care providers. The Affordable Care Act (commonly referred to as “Health Care Reform”) mandated that CMS launch such a website and that it implement physician performance metrics […]

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Predictive Modeling: ZPICs Using Data Mining to Identify Medicare Fraud

Medicare, Medicaid & Private Payor Updates /

(April 15, 2011): Over the last decade, the Centers for Medicare and Medicaid Services (CMS) and its contractors (Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Recovery Audit Contractors (RACs)), have steadily assembled an extensive database of the coding and billing practices of Medicare providers around the country. Analyzing this data, contractors have

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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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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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CMS Authorizes Medicare Appeals by Fax and Secured Internet

Medicare, Medicaid & Private Payor Updates /

(November 21, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating that this change

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Existing Home Health Agencies Considered a Moderate Risk

Home Health & Hospice /

(October 5, 2010): Existing home health agencies are considered to be a Moderate Risk for screening purposes. Late last month, the Centers for Medicare & Medicaid Services (CMS) published a Proposed Rule entitled “Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance.” As set out

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CMS Issues Medical Record Retention Reminder: MLM Matters SE1022

Medicare, Medicaid & Private Payor Updates /

(August 17, 2010): Last week, the Centers for Medicare and Medicaid Services (CMS) issued MLM Matters SE1022, titled “Medical Record Retention and Media Formats for Medical Records” directed toward physicians, non-physician practitioners, suppliers, and other health care providers submitting claims to Medicare contractors for services provided to Medicare beneficiaries. As CMS acknowledged, medical record retention

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