Home Blog Category

Category

OCR recoups over $10M in one week

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...

Read Full Post

MACs Medical Review get official start date

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...

Read Full Post

More details on Medicare Audits beginning August 3

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...

Read Full Post

CMS ABN form updated

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...

Read Full Post

COVID-19 Fraud Alert

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...

Read Full Post

CMNs and ABNs are nearing expiration...what do you do?

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,...

Read Full Post

Decoding the Standard Written Order (SWO)

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...

Read Full Post

SMRC warns 'No Response Providers' of E & M audit risk

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...

Read Full Post

Avoiding Same or Similar Claim Denials

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....

Read Full Post

Do’s and Don’ts: Amending a Medical Record

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...

Read Full Post