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 MoreFlorida 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
Read MoreHealth 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 MoreThe 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
Read MoreOn 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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