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5 Jun 2018, 12:25 pm by Sabrina I. Pacifici
The Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) prepares the report under the direction of the Boards. [read post]
5 Jun 2018, 8:00 am by Daniel Anders
Ron Kind, D-Wisc, requires the Centers for Medicare and Medicaid Services (CMS) to share information on not only whether a claimant is a Medicare beneficiary, but also whether the claimant is enrolled in a Part C Medicare Advantage (MA) Plan, Part D Prescription Drug Plan or Medicaid. [read post]
1 Jun 2018, 10:00 am
., Board Certified by The Florida Bar in Health Law The Centers for Medicare & Medicaid Services (CMS) released a Memorandum in an effort to clarify their stance and guidelines on texting between healthcare providers and members of a healthcare team. [read post]
31 May 2018, 9:38 pm
., Board Certified by The Florida Bar in Health Law The Centers for Medicare & Medicaid Services (CMS) released a Memorandum in an effort to clarify their stance and guidelines on texting between healthcare providers and members of a healthcare team. [read post]
Authorities Uncover $20 Million Health Care Scheme in California Federal authorities arrested five individuals connected to San Fernando Valley clinics and a significant health care fraud scheme. On May 22, a federal grand jury indictment was unsealed. The indictment alleges that the five individuals engaged in a health care fraud conspiracy over multiple years and targeted at least eight health insurance companies and the International Longshore and Warehouse Union, the Pacific Maritime Association Benefit Plan, and the Federal Employees Health Benefits Program. The Conspirators According to the Department of Justice (DOJ) press release, the co-conspirators included: Roshanak “Roxanne” or “Roxy” Khadem, 50: Khadem owned and operated two clinics, R&R Med Spa and Nu-Me Aesthetic and Anti-Aging Center. Dr. Roberto Mariano, 59: Mariano helped operate the clinics. Marina Sarkisyan, 49: Sarkisyan was a clinic office manager. Lucine Ilangezyan, 38: Ilangezyan was an insurance biller for the clinics. Gary Jizmejian, 44: Jizmejian was previously a senior investigator at the Anthem Special Investigations Unit, the insurer’s anti-fraud unit. The Allegations The indictment alleges that the co-conspirators induced patients to visit the clinics for free cosmetic procedures, such as Botox injections, facials, and laser hair removal. These procedures were not covered by insurance. The co-conspirators would gain the patients’ insurance information and bill their insurers for medical services that were unnecessary or never provided. The defendants then used some of the illegally obtained proceeds to calculate a “credit” the patients could use for discounted or free cosmetic procedures. The defendants submitted at least $20 million in insurance claims and were paid approximately $8 million. The indictment also states that Jizmejian, for cash payments, would provide Khadem and others with confidential Anthem information. This information helped the defendants submit fr
30 May 2018, 5:43 am by Gregory J. Brod
If you have evidence regarding fraud perpetrated against a state or federal health care program, such as Medicare or Medicaid, then you should contact a skilled San Francisco health care fraud attorney at Brod Law Firm right away. [read post]
29 May 2018, 4:55 pm by Jerri Lynn Ward, J.D.
The Centers for Medicare & Medicaid Services (CMS) is announcing  that under the new program, home health agencies (HHAs) could choose to undergo either pre-claim or post-payment reviews, or to forgo reviews but take a 25% payment reduction on all claims submitted for home health services. [read post]
25 May 2018, 11:02 am by Shriver Center
Expanding and diversifying the dental workforce is a promising strategy for addressing provider shortages and improving access to oral healthcare, and states that put fewer restrictions on dental hygienists see better dental health outcomes in adults.Increase the list of services covered by Medicaid to enable health providers to better support, educate, and engage with their patient communities, including parents and caregivers of young children and individuals with… [read post]
24 May 2018, 12:58 pm by Wachler & Associates, P.C.
On May 7, 2018, the Centers for Medicare and Medicaid Services (“CMS”) released a proposed rule that would rebrand the current Medicare and Medicaid Electronic Health Records (“EHR”) Incentives program into the Promoting Interoperability program (“PI”). [read post]
24 May 2018, 12:58 pm by Wachler & Associates, P.C.
On May 7, 2018, the Centers for Medicare and Medicaid Services (“CMS”) released a proposed rule that would rebrand the current Medicare and Medicaid Electronic Health Records (“EHR”) Incentives program into the Promoting Interoperability program (“PI”). [read post]
23 May 2018, 8:25 am by The Lawrence Law Group
  These three nursing homes have received high rankings from the Centers for Medicare and Medicaid Services, respectively earning five stars, three stars and five stars on CMS’ one to five star rating system. [read post]
23 May 2018, 8:25 am by The Lawrence Law Group
  These three nursing homes have received high rankings from the Centers for Medicare and Medicaid Services, respectively earning five stars, three stars and five stars on CMS’ one to five star rating system. [read post]
22 May 2018, 11:23 am by Laura Ray
  The Departments found the application to be incomplete, as communicated to the Ohio Department of Insurance in a 5/17/18 letter from Randy Pate, Director of the Center for Consumer Information & Insurance Oversight (CCIIO) and Deputy Administrator of the Centers for Medicare & Medicaid Services. [read post]
22 May 2018, 9:00 am by Michael H Cohen
Doctors who use a telemedicine practice must understanding which services they can bill Medicare, Medicaid for, and private insurance carriers. [read post]
22 May 2018, 6:30 am by Michael B. Stack
Since a majority of workers’ compensation settlements involve Medicare Set-Asides, the professional administrator should be able to competently handle all reporting aspects required by the Centers for Medicare and Medicaid Services. 24-Hour Help. [read post]
21 May 2018, 1:08 pm by Michael B. Stack
Since the advent of the Medicare Set-Aside review process in 2001, the Centers for Medicare and Medicaid Services (CMS) has added policies and contractors to its enforcement mechanisms under the Medicare Secondary Payer Act. [read post]
20 May 2018, 2:26 pm by Robert Liles
  As the Centers for Medicare and Medicaid Services (CMS) has expressly noted in Chapter 2, Section 2.3 of the Medicare Program Integrity Manual (MPIM): “Claims data is the primary source of information to target abuse activities. [read post]
20 May 2018, 2:26 pm by Robert Liles
  As the Centers for Medicare and Medicaid Services (CMS) has expressly noted in Chapter 2, Section 2.3 of the Medicare Program Integrity Manual (MPIM): “Claims data is the primary source of information to target abuse activities. [read post]
17 May 2018, 12:36 pm
If you have both Medicare and Medicaid coverage and are enrolled in a Qualified Medicare beneficiary program, providers are usually not even allowed to bill you the Medicare co-pays and deductibles.If you receive a bill that you believe should be covered by insurance, Medicaid, or Medicare, contact your insurer to find out why the service was not covered. [read post]
16 May 2018, 8:57 am by Debra A. McCurdy
The Centers for Medicare & Medicaid Services (CMS) has published a proposed rule to update Medicare rates for inpatient rehabilitation facility (IRF) services for fiscal year (FY) 2019. [read post]
15 May 2018, 12:30 pm by Wachler & Associates, P.C.
  In 2010, the Centers for Medicare & Medicaid Services (“CMS”) imposed stricter rules on billing for simple urine screens; however, these rules do not cover machine testing. [read post]