Hospice Successful Overpayment Appeal
Successful Appeal of CMS overpayment determinations against Hospice provider.
Read MoreCategory Archives: Overpayment
Florida Health Care Clinic license application submission on behalf of health care providers.
Florida Health Care Clinic license application submission on behalf of health care providers should be handled by experienced health care attorneys.
Read MoreAppeal 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]
Read MoreSuccessful 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
Read MoreResponding 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 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 MoreHow 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
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 MoreFlorida 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
Read MoreAHCA 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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