Category Archives: Health Care

18 Oct

Changes to the Amount in Controversy Thresholds for Medicare Appeals

Beginning on or after January 1, 2020, the amount in controversy needed by Medicare providers will change as follows: $170 for Administrative Law Judge (ALJ) hearings. (2019 – $160) $1,670 for judicial review (2019 – $1,630) The Center for Medicare and Medicaid Services (CMS) every year announces annual adjustments to the amount in controversy threshold

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11 Feb

Home Health Agencies no longer under CMS moratorium

As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State, including Florida, or U.S. territories. On July 31, 2013, the the Centers for Medicare and Medicaid Services (CMS) first issued a temporary moratorium which affected providers who desired to or where in the process of enrolling as a home

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11 Feb

How to respond to a Final Audit Report (FAR)

Florida health care providers that provide services to Medicaid recipients are likely, at some point, to receive an audit of their claims submitted to the Medicaid program for reimbursement. Some providers will, for any number of reasons, receive a preliminary audit report detailing the Agency for Health Care Administration’s (Agency) findings as well as setting

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07 Feb

Florida Behavior Analysis Services – Overpayments

The Florida Agency for Health Care Administration (Agency), Medicaid Program Integrity (MPI) has and is undergoing review of several Behavior Analysis Services providers regarding their Medicaid reimbursement claims for services rendered. MPI is reviewing said claims in order to insure compliance with the program’s Florida Medicaid Behavior Analysis Services Coverage Policy dated October 2017, including

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22 Jun

FDA Targets Online Sales of Illegal Prescription Drugs

On June 9, 2016, The U.S. Food and Drug Administration (FDA) announced that it took action against 4,402 websites illegally selling unapproved prescription drugs to U.S. consumers. With the assistance of U.S. Customs and Border Protection, the FDA conducted inspections at International Mail Facilities (IMFs) and served formal complaints on domain registrars “requesting the suspension

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07 May

Success of CMS ACO Pilot could bring big changes to Medicare payment structure

The Center for Medicaid and Medicare Services’ (CMS) Pioneer Accountable Care Organization (ACO) program successfully saved Medicare nearly $400 million in spending over two years, clearing the way for CMS begin expanding the program nationwide. A CMS study released May 4, 2015 on the JAMA website, revealed that expenditures for Medicare beneficiaries receiving care through

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17 Sep

AHCA Increases Efforts to Collect Medicaid Overpayments

On September 16, 2014, Florida’s Agency for Health Care Administration (AHCA) issued a notice to Medicaid providers informing that “in the upcoming weeks the Agency will increase its efforts to ensure that providers are repaying overpayments”, while also reminding Medicaid providers of “their obligation to promptly refund moneys due to [AHCA], including any moneys received

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