Medicare

Coverage and Payment of New Products – CPT / HCPCS Code Issues

Medicare, Medicaid & Private Payor Updates /

(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

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How to Implement a Compliance Plan in Your Practice

Medicare, Medicaid & Private Payor Updates /

(September 17, 2015): Despite the fact that Medicare and Medicaid requires that participating providers implement a compliance plan, most small providers have yet to complete the necessary steps to accomplish this requirement.  “My office manager went to a continuing education program, and she’s come back telling me we need a compliance program. I don’t know about

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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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Are More Home Health Program Integrity Initiatives on the Horizon?

Home Health & Hospice /

(April 22, 2015): Late last month, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) released its 2015 “Compendium of Unimplemented Recommendations” (Compendium). Published annually, the Compendium sets out the top 25 program integrity issues previously identified by HHS-OIG that are expected to “most positively impact HHS programs in terms of cost

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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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Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers

Medicare, Medicaid & Private Payor Updates /

(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were

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The Medicare Administrative Appeal Process

Medicare, Medicaid & Private Payor Updates /

(March 25, 2011): Zone Program Integrity Contractors (ZPICs) have established themselves as the preeminent audit tool of the Centers for Medicare and Medicaid Services (CMS), surpassing both Recovery Audit Contractors (RACs) and Medicare Administrative Contractor (MAC) Benefit Integrity units. Unfortunately, many health care providers and suppliers wait until notice of an audit has been received

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