Category Archives: Health Care

15 Sep

Appeal of UPIC Audit Overpayment Determinations – A Multi-Step Approach

Mr. Gaitan is available to discuss his strategies and legal costs, including hourly and contingency fee arrangements with provider’s who have received a records request or have received an overpayment determination and demand letter from their MAC or would like to more about the process. Initial consultation fee is waived. Feel free to contact Rafael (Ralph) Gaitan, Esq. at (786) 440-8115 or via email at [email protected]

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27 Jul

Successful Appeal of Medicare Extrapolated Overpayments – Saving Millions of Dollars.

Recently, the Firm has successfully challenged Medicare extrapolated overpayments resulting in various favorable decisions saving our clients (hospice and home health agencies) millions of dollars in overpayment amounts recouped by CMS or paid back via voluntary extended repayment plans. The Firm’s successful appeals resulted in complete removal of the statistical overpayments reducing any amounts owed

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27 Jun

Appeal of CMS Revocation and Enrollment Bar – Physicians Take Note.

The Centers for Medicare & Medicaid Services allows for the enrollment of various types of providers to participate in the Medicare program for reimbursement of medical services provided to beneficiaries. Typically, physicians get credentialed into the Medicare program through their employers. The employer’s staff prepares and assists with the submission of the physician’s initial enrollment

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29 Jan

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

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10 Jan

Reminder – Deadline for Licensure required of Behavior Analysis Providers

Starting the New Year in 2020 means that Behavior Analysis providers in Florida will need to have a health care clinic license or exemption from licensure in order to avoid possible Medicaid payment interruptions. The deadline for compliance is July 1, 2020, however, the time to submit an application is now. For additional information regarding

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29 Oct

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,

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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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