Telehealth Services Amid COVID-19 and Flexibility to Waive Co-pays, Coinsurance, and Deductibles.
Waiver of Telehealth co-pays, coinsurance, and deductibles during COVID-19 Outbreak.
Read MoreCategory Archives: Medicare Reimbursement
Responding to the Omissions Notice.
The changes in Florida’s Medicaid enrollment and participation rules and regulations require that many previously unlicensed behavior analysis entities seek either licensure as health care clinic or seek exemption from licensure. See our previous post for additional facts regarding same here. As a result, many behavior analysis providers will need to file for licensure with
Read MoreHow to Avoid Medicare Payment Interruptions After January 1, 2020
Attention Medicare providers! if you want to continue receiving Medicare payments without delay please ensure that your practice or billing provider is using MBIs for all Medicare transactions as soon as possible and prior to January 1, 2020. As you may recall, The Centers for Medicare and Medicaid Services (CMS) is requiring that “physicians, providers,
Read MoreChanges 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
Read MoreResponding to Record Requests on a Timely Basis.
Health care providers are increasingly seeing request for records from all types of payors including but not limited Medicaid, Medicare and commercial insurance providers. The basis for receiving a requests for records could be as a result on any number of reasons, including compliance, aberrant billing practices or as a result of a ZPIC audit
Read MoreHospital enters $85 million settlement for alleged Stark Law violations
Halifax Hospital agreed Monday, March 3, 2014, to settle a whistleblower case for alleged Stark Law violations with the U.S. Justice Department in the amount of $85 million — an amount so large it is more than twice the previous recors for hospital systems accused of Medicare fraud. The Daytona Beach, Florida hospital is accused of
Read MoreGaitan Law Group Successfully Reduces a $736,305.93 Overpayment to $6,826.00
CMS sought recovery of an alleged overpayment in excess of $730,000 from a diagnostic laboratory, upon the conclusion and recommendation of Safeguard Services (SGS) to deny all claims submitted for 3,006 Medicare beneficiaries. Mr. Gaitan and Mr. Suarez, of our health care practice group, appealed the overpayment claim through the reconsideration (second level appeal),
Read MoreMedicare delays RAC demonstration program intended to hold back payments to hospitals
CMS has announced that it will postpone its Recovery Audit (RAC) Prepayment Review demonstration project that would have held up payments to hospitals until the Medicare RAC reviews the claim to ensure that the provider complied with all Medicare payment rules. The Medicare RAC Prepayment Review demonstration called for the RACs to conduct prepayment review of claims for 15 procedures that historically result in high rates of improper payments. Many doctors were unhappy with the proposed program, especially cardiologists, who would be most affected since 11 of the 15 procedures identified for Medicare RAC prepayment review affect cardiologists.
Read More