October 19, 2020 By Kelli Ogunlesi, CHP, HIPAAwise Success Manager
The last week of September proved to be a very busy one for the Office of Civil Rights (OCR), the federal agency responsible for enforcing HIPAA privacy and security rules. From September 21 through... August 6, 2020 Today, CMS released more details on the medical review program since announcing audits would resume on August 3. This week's CMS MLN Connects newsletter included the headline "MACs Resume Medical Review on a Post-Payment Basis".
In the article, it... July 21, 2020 In recent meetings with CMS, we have learned that while the date to begin medical review functions is August 3rd, there will likely be a delayed time frame before audit requests officially go out. CMS is currently working to develop instructions for... June 29, 2020 CMS has updated the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131). Providers can use the new form now, and mandatory use of the form will be on 8/31/2020. The form is valid through 06/30/2023. On or after 8/31/2020, issuing an ABN... April 20, 2020 By Wayne van Halem, AHFI, CFE, President of The van Halem Group
As an Accredited Healthcare Fraud Investigator and Certified Fraud Examiner, I must attend courses to obtain CEUs to maintain my accreditation and certification. I attended one last week... February 5, 2020 By Carrie Nienberg, RN Clinical Director
CMNs for Oxygen, Pneumatic Compression Devices, Osteogenesis Stimulators, Transcutaneous Electrical Nerve Stimulator (TENS), Seat Lift Mechanisms, External Infusion Pumps, Enteral and Parenteral nutrition,... January 16, 2020 On January, 1 2020, CMS made it effective that only one type of order is needed for DMEPOS claims, in an effort to help reduce supplier and provider burden. As such, the preliminary/dispensing order, Detailed Written Order (DWO), Five Element Order (5EO)/Written... January 6, 2020 In the SMRC's (Supplemental Medical Review Contractor) most recent current project detail for Diabetic Test Strips, they include verbiage that not only impacts the DME supplier, but also the ordering practitioner.
Specifically the SMRC's current... October 28, 2019 By Donna Youngblood RN, BSN, CPC
Same or similar denials occur when claims information is
checked against the patient’s CMN history. This will indicate when equipment is
“same or similar” to that piece of equipment being billed on the claim.... October 21, 2019 By Donna Youngblood RN, BSN, CPC
Do you find it difficult to explain to your referral source how to properly amend a patient's medical record, particularly after the document has been signed? The van Halem Group is aware of this challenge and has...
OCR recoups over $10M in one week
MACs Medical Review get official start date
More details on Medicare Audits beginning August 3
CMS ABN form updated
COVID-19 Fraud Alert
CMNs and ABNs are nearing expiration...what do you do?
Decoding the Standard Written Order (SWO)
SMRC warns 'No Response Providers' of E & M audit risk
Avoiding Same or Similar Claim Denials
Do’s and Don’ts: Amending a Medical Record
