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4 Apr 2012, 10:25 am
In my most recent review of a few PIP Files, I have learned the following pieces of information which I am confident will get my client thousands of extra dollars in case evaluations and, hopefully, result in successful motions for summary dispositions where interest and attorney fees will be granted: The adjuster log notes admitted that the adjuster failed to send my client notification of its termination but adjuster did admit in writing that the adjuster owed all benefits for their pre-… [read post]
13 Mar 2018, 6:30 am
During her tenure as chief operating officer, many new service offerings were developed, including: the BOLD® Network, a unique, state-stratified, multi-tiered approach to a preferred provider organization (PPO) strategy; a durable medical equipment (DME) formulary that applies the cost management principles of a pharmacy formulary to medical equipment; and a new chronic pain protocol, a multidisciplinary approach to addressing the complex chronic pain conditions that drive the… [read post]
31 Mar 2020, 8:38 am
Section 3712, Revising Payment Rates for DME Under Medicare During the Emergency Period: This Section prohibits scheduled payment reductions in Medicare DME during 2020 and the emergency period. [read post]
15 Nov 2011, 4:27 pm
And the Democrats would also cut $5 billion for Medicaid's "DME," which presumably means "durable medical equipment" like crutches and wheelchairs. [read post]
18 Jun 2011, 11:54 am
(June 18, 2011): As a review of the last several quarters of Medicare appeals statistics reflects, an overwhelming percentage of Medicare providers appealing alleged overpayments through the Medicare administrative appeals process have chosen to “throw in the towel,” so to speak, when they have lost at the reconsideration level. [read post]
23 Oct 2012, 3:52 am
This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider. [read post]
27 Mar 2009, 10:18 am
I call them “Insurance Medical Exams,” or better yet, DME’s or “Defense Medical Exams. [read post]
22 Jun 2020, 6:30 am
The most popular workers compensation abbreviations include: AWW: Average weekly wage – the average earnings of an employee based on a set number of weeks (or months) prior to the injury C: Claimant – the injured employee Clmt: Claimant CMS: Centers for Medicare and Medicaid Services – the federal government agency that oversees the Medicare and Medicaid programs CMS: Claim management system – within context, the computer system used with the claim handling… [read post]
29 Feb 2012, 4:28 am
In addition to the data mining tools highlighted in the Medistat indictments, other new tools helping to boost the success of federal health care fraud investigation and prosecution include: • Tough new rules and sentences for criminals • Enhanced screening and other enrollment requirements • Increased coordination of fraud prevention efforts • Health Care Fraud Prevention and Enforcement Action Team (HEAT) • New focus on compliance and prevention • Expanded… [read post]
18 Mar 2010, 8:25 pm
Filed under: Employee Benefits, Employers, ERISA, Health Care Reform, Health Plans, Human Resources, Insurance, Public Policy, Risk Management Tagged: DME, Employers, ERISA, H.R. 4872, Health Care Reform, Health Plans, Hospitals, Medicaid, Medicare, Pharma, Physicians [read post]
26 Jan 2023, 8:27 am
Examples of such services include intensive surgeries, long term care services, and larger DME purchases. [read post]
10 Feb 2014, 3:06 am
The first is CTNY Investors 3, LLC v DME CRE Opportunity Fund I LP, 2014 NY Slip Op 30268(U) [Sup Ct NY County Jan. 29, 2014], decided last month by Manhattan Commercial Division Justice Shirley Werner Kornreich. [read post]
19 Jan 2021, 8:43 pm
One the edit is put in place, the only way for it to be removed is for the provider or supplier to effectively show (through their submission of a claim’s supporting documentation), that the medical services or DME supplies at issue are medically necessary and qualify for coverage and payment. [read post]
13 Dec 2024, 5:00 am
This article of mine was published in the Pennsylvania Law Weekly on December 9, 2024 and is republished here with permission.The Rise of AI and Other Changes Abound in the Law: A 2024 Year-End ReviewDecember 09, 2024By Daniel E. [read post]
7 Feb 2023, 6:19 pm
On February 7, the Department of Justice released its accounting of fraud recoveries and accomplishments for fiscal year 2022 (ending last September 30). [read post]
12 Sep 2020, 11:46 am
A number of sober homes have therefore engaged a licensed physician to serve as the facility’s Medical Director to oversee and order periodic drug screening tests to verify an individual’s compliance with the rules.[6] Drug screening tests (such as a urinalysis) conducted on insured patients are then billed by the testing In addition to engaging a Medical Director, a sober home may also establish a business relationship with a testing laboratory and with other types of… [read post]
12 Apr 2017, 9:35 pm
Stamer has worked closely with a diverse range of physicians, hospitals and healthcare systems, DME, Pharma, clinics, health care providers, managed care, insurance and other health care payers, quality assurance, credentialing, technical, research, public and private social and community organizations, and other health industry organizations and their management deal with governance; credentialing, patient relations and care; staffing, peer review, human resources and workforce performance… [read post]
13 Dec 2018, 12:15 pm
February 12, 2019 is the deadline for health plans and their sponsoring employers, fiduciaries and business associates, as well as health care providers, health care clearinghouses, health care consumers, employer and other concerned persons to provide input on reducing the regulatory burdens of the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Breach Notification Rules in response to the December 12, 2018 invitation of the U.S. [read post]
12 May 2017, 2:39 pm
U.S. agencies are warning U.S. businesses to batten down their cyber security defenses to guard against a WannaCry ransomware cybersecurity threat sweeping the Globe. [read post]
12 May 2017, 4:54 pm
U.S. agencies are warning U.S. businesses to batten down their cyber security defenses to guard against a WannaCry ransomware cybersecurity threat sweeping the Globe. [read post]
