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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]
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]
29 May 2023, 10:00 am
Medicare Advantage Plans are Aggressively Denying Claims – Administrative Appeals are Growing (May 25, 2023): According to the latest data released by the Centers for Medicare and Medicaid Services (CMS), beneficiaries participating in Medicare Advantage[1] plans now surpass those enrolled in original Medicare plans. [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]
6 May 2019, 5:44 pm
Health plans, their sponsoring employers and unions, insurers, fiduciaries, administrators, insurers and other service providers should learn from the $3 million lesson a Franklin, Tennessee-based diagnostic medical imaging services provider is learning about the heavy penalties a health plan, health care provider, health care clearinghouse or business associate (“Covered Entity”) risks if a post-data breach investigation by the U.S. [read post]
10 Sep 2018, 7:49 pm
House Republicans are taking action to make permanent the individual and small business tax cuts enacted under the Tax Cuts and Jobs Act (TCJA) by introducing the following three bills to accomplish Republicans’ Tax Reform 2.0 package: H.R. 6760, the Protecting Family and Small Business Tax Cuts Act of 2018, sponsored by Rep. [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]
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]
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]
10 Oct 2023, 10:51 am
During FY 2022, the Centers for Medicare and Medicare Services (CMS) has estimated the Medicare Part B improper payment rate as 8.41%. while the improper payment rate for Durable Medical Equipment (DME) suppliers was estimated to be 25.24%.[2] Additionally, the Medicaid program improperly paid $80.6 billion in improper claims during FY 2022.[3] Notably, these estimates don’t even take into account the sizeable improper billings submitted to private payors. [read post]
26 Sep 2022, 3:46 am
Incident To Billing Practices are Under Law Enforcement’s Microscope. [read post]
20 May 2018, 2:26 pm
An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions (May 20, 2018): It’s been a rough week for at least one Texas rheumatologist. [read post]
13 Jul 2018, 10:37 pm
A flurry of activity in the House Ways & Means Committee and other Congressional committees over the past few weeks signals the advisability of keeping a close eye on health care and health benefit reform proposals this Summer in anticipation of both the Fall health benefit enrollment and renewal season and the mid-term November Congressional elections. [read post]
