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RAC adds two new topics to CMS approved audits issues list

Performant, the national home health, hospice, and DMEPOS recovery audit contractor (RAC), added two new items to their CMS approved audit issues list. Both are identified as complex reviews, meaning providers that bill these services could be subject...

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CMS lifts Moratoria for Medicare Provider Enrollment

On January 30, 2019, CMS posted to their website that "As of January 30, 2019, there are no active Medicare Provider Enrollment Moratoria in any State or U.S. territories." The Provider Enrollment Moratoria Waiver Demonstration will end when the moratoria...

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CMS quietly updates TPE terms

On November 28, 2018, CMS rescinded and replaced Transmittal 1919 with 2207 to clarify language that more accurately instructs MACs on subsequent rounds of the Targeted Probe and Education (TPE) initiative. Specifically, CMS advised MACs that the...

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Home Health Review Choice Demonstration: What you need to know now

On November 27, 2018 CMS held a special open door forum to update Home Health Services providers on the soon to begin review choice demonstration. The van Halem Group participated and took notes for you! Here's what you need to know right now. Who...

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Protect Your Business from Audits: Be Proactive with Billing E&O Insurance and Compliance Measures

Being audited by a RAC or UPIC can be incredibly stressful for any health care provider, whether you’re a home medical equipment provider, a physical therapy practice, or a home health agency. Getting fined for billing errors that result in overpayment...

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Pre-claim Review to Return to Home Health?

CMS recently announced the likely return of pre-claim reviews in Medicare home health. The return presents a new version of claim review that would give Home Health Agencies (HHAs) the option of 100% pre-claim review or 100% post-claim review. HHAs that...

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Appeals settlements: SCF or LVA...Should I choose one or none at all?

If you have appeals pending at the Administrative Law Judge level awaiting a hearing, then you have probably heard a lot of buzz around CMS settlement processes. One option is the Settlement Conference Facilitation (SCF), an alternative dispute resolution...

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OIG Report Identifies Common Characteristics in OIG Home Health Fraud Cases

Home health has long been recognized as a program area vulnerable to fraud, waste, and abuse. In 2015, Medicare reimbursed more than 11,000 home health agencies (HHAs) for almost 7 million episodes of home health care, totaling approximately $18.4 billion....

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2017 OIG Work Plan for Home Health Agencies

The OIG has published their Work Plan for 2017, which summarizes new and ongoing projects the OIG plans to pursue with respect to HHS programs and operations. Why is that important to you? Because once the OIG identifies their areas of focus, audit contractors...

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