Search for: "CMS CONTRACT MANAGEMENT SERVICES"
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13 Jan 2021, 8:47 pm
While there are a number of benefits to such a model, both State regulatory entities and Federally-contracted Unified Program Integrity Contractors (UPICs) working for the Centers for Medicare and Medicaid services (CMS) have shown their concern regarding these organizations. [read post]
12 Jan 2021, 9:58 am
For example, the Bureau could have units dedicated to credit cards, mortgages, small dollar loans, fintech, and third party service providers (such as debt collectors and mortgage servicers), with each unit having enforcement, rulemaking, and supervision responsibilities. [read post]
29 Dec 2020, 4:00 pm
Allows HDHPs to cover telehealth and other remote care services without participants satisfying their plan deductible. [read post]
23 Nov 2020, 3:51 pm
Additionally, the final rule modifies the following existing AKS safe harbors: Local transportation; Warranties; Electronic health records arrangements; and Personal service and management contracts. [read post]
10 Nov 2020, 10:31 am
Services can be temporary, contract based, subscription based or one-off task support. [read post]
1 Oct 2020, 3:51 pm
Specifically, this Bulletin relaxes requirements for insurers to conduct on-site reviews of managing general agents and third-party administers in 2020, and for 2020 only. [read post]
28 Sep 2020, 8:58 am
“On-Site Review” as a Basis for a Home Health Revocation Action: In recent years, our attorneys have represented numerous home health agencies whose enrollment and Medicare billing privileges have been revoked due to the fact that an unannounced, on-site visit by a CMS-contracted inspector found that the provider was no longer operational to furnish Medicare covered home health services. [read post]
28 Sep 2020, 8:58 am
“On-Site Review” as a Basis for a Home Health Revocation Action: In recent years, our attorneys have represented numerous home health agencies whose enrollment and Medicare billing privileges have been revoked due to the fact that an unannounced, on-site visit by a CMS-contracted inspector found that the provider was no longer operational to furnish Medicare covered home health services. [read post]
25 Sep 2020, 11:41 am
Since 1994, CMS has participated in an interagency agreement with the DOJ which allows CMS pro [read post]
25 Sep 2020, 11:41 am
Through an analysis of billing data, UPICs have noted that some DME suppliers have billed Medicare for items based on orders issued by a physician, nurse practitioner or physician assistant who did NOT bill Medicare for an associated Evaluation and Management (E/M) service, either directly or through an appropriate reassignment relationship. [read post]
12 Sep 2020, 11:46 am
While most health care and providers obtained a temporary reprieve from, Medicare, Medicaid and private payor administrative audits[1], many state and federal law enforcement agencies (such as the Federal Bureau of Investigation (FBI), the Department of Health and Human Services, Office of Inspector General (OIG), state Medicaid Fraud Control Units (MFCUs) have continued to investigate allegations of wrongdoing against sober home and recovery residence owners, operators, managers… [read post]
1 Jul 2020, 1:06 am
In this case comment, Adrian Bell, Nigel Lewis, Steven Bell and Shona Frame, all partners within the CMS Infrastructure, Construction and Energy Disputes Group, comment on the decision handed down in June 2020 in the matter of Bresco Electrical Services Ltd (in liquidation) v Michael J Lonsdale (Electrical) Ltd [2020] UKSC 25: The Supreme Court has overturned a Court of Appeal decision heavily limiting the ability of insolvency practitioners to commence and… [read post]
26 Jun 2020, 6:24 am
On 1 April 2015, the Committee of Ministers adopted a new Recommendation on the processing of personal data in the employment context (CM/Rec(2015)5) at the 1224th meeting of the Ministers’ Deputies.[7] This revised recommendation was motivated due to “the changes which have occurred internationally in the employment sector and related activities, notably due to the increased use of information and communication technologies (ICTs) and the globalisation of employment and… [read post]
3 Jun 2020, 1:07 pm
Government investigators claimed that the provider was improperly reimbursed for Medicaid after-hours services, in contravention to the billing requirements set out in the provider’s Medicaid managed care contract and HHSC program policy.[5] That same month, the government regulators reached a similar settlement with a physician practice in Mission, Texas in the amount of $61,310. [6] Notably, Texas has recently upped-the-ante, so to speak, by issuing a… [read post]
3 Jun 2020, 1:07 pm
Government investigators claimed that the provider was improperly reimbursed for Medicaid after-hours services, in contravention to the billing requirements set out in the provider’s Medicaid managed care contract and HHSC program policy.[5] That same month, the government regulators reached a similar settlement with a physician practice in Mission, Texas in the amount of $61,310. [6] Notably, Texas has recently upped-the-ante, so to speak, by issuing a… [read post]
19 May 2020, 6:30 am
Getting CMS approval for MSAs is a complicated process, fraught with potential landmines. [read post]
18 May 2020, 8:48 am
Thus, all medical practice managers and healthcare providers should be aware of CMS’s process of contracting with Uniform Program Integrity Contractors (UPIC’s), private entities hired by CMS to audit providers suspected of fraud. [read post]
6 May 2020, 6:28 am
Ever since 2014, Congress has continued to pass an appropriations rider that would restrict CMS program management funds from being used to make risk corridors payments, and by the end of the risk corridors program in 2016, the “program’s deficit exceeded $12 billion. [read post]
13 Apr 2020, 4:52 pm
The ECtHR held that the rights and interests of others and of society as a whole may entitle Contracting States ‘to impose liability on Internet news portals, without contravening Article 10 of the Convention, if they fail to take measures to remove clearly unlawful comments without delay, even without notice from the alleged victim or from third parties’. [read post]
8 Apr 2020, 9:56 am
Indeed, one of the first major US clusters of COVID 19 cases came from within a long-term residential care facility in Kirkland, Washington, where 81 residents, 34 staff members, and 14 visitors contracted COVID 19. [read post]
