Hospice Successful Overpayment Appeal
Successful Appeal of CMS overpayment determinations against Hospice provider.
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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]
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 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 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 MoreRAC expands to State Medicaid Program
Through an Oct. 1 letter to State Medicaid Directors, Peter Budetti, Deputy Administrator for the Center for Medicare and Medicaid Services (CMS), provided initial guidance on the implementation of the Recovery Audit Contractor (RAC) programs by State Medicaid agencies. Section 6411 of the Affordable Care Act, calls for the expansion of the RAC Program by
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