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 MoreTag Archives: Medicare Reimbursement
How 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 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 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 MoreCommunity Pharmacy Re-permitting Required Before July 1, 2012
Section 465.018, Florida Statutes was amended in 2011, by HB 7095 to require every community pharmacy that dispenses Schedule II and Schedule III controlled substances to be re-permitted by July 1, 2012. All owners, officers, and prescription department managers of the community pharmacy will need to submit fingerprints to the Department of Health as part of the permitting process; and the community pharmacy must implement written policies and procedures for preventing controlled substance dispensing based upon fraudulent representations or invalid practitioner-patient relationships. To avoid disruptions to a business, community pharmacies are advised to begin the permitting process immediately. For assistance and guidance with applying for a community pharmacy permit, developing policies and procedures for preventing controlled substance dispensing fraud and abuse, or to appeal a permit denial or revocation, contact Rafael A. Gaitan, Esq. Mr. Gaitan has over 15 years experience in the health care industry, regularly representing pharmacies and pharmacist before regulatory bodies like the Florida Department of Health, and the Board of Medicine. Mr. Gaitan can be reached via e-mail at [email protected] or via telephone at 305.329.1462.
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.
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