Home Health & Hospice Week
With Medicare's Recovery Audit Contractors and other fraud hunters turned loose
With Medicare's Recovery Audit Contractors and other fraud hunters turned loose thanks to health care reform, gear up to submit more appeals. Just make sure you know the latest on amount-in-controversy requirements. CMS has spelled out requirements for the claim amount in controversy for you to file a levelthree (administrative law judge hearing) and levelfive (federal district court) appeal. New thresholds take effect Aug. 9, according to May 7 Transmittal No. 1965 (CR 6894). Starting then, at least $100 must remain in controversy to file an ALJ appeal, and for requests filed on or after Jan. 1, 2010, at least $130 must remain in controversy. At least $1,000 must be at stake to file a federal district court appeal, and for requests filed on or after Jan. 1, 2010, at least $1,260 must remain in controversy. The transmittal is online at www.cms.gov/transmittals/downloads/R1965CP.pdf. A related MLN Matters article is at www.cms.gov/MLNMattersArticles/downloads/MM6894.pdf.
Home Health & Hospice Week
- Diagnosis Coding:
Check Out These New Diagnosis Codes For 2011
Welcome detailed H1N1 pneumonia combination codes. New pneumonia, fluency disorder, and cystostomy complication codes are [...] - Fraud & Abuse:
Fraud-Fighting Program Ramps Up
In 2009, the Senior Medicare Patrol Project collected triple its 2008 amount. The government recruits [...] - Know Your Facts:
Here's Where The Senior Medicare Patrol Project Is Most Active
New York and Michigan have beefed up their SMP rosters, while other states, such as [...] - Compliance:
In Heightened Compliance Environment, Examine Reporting Hierarchy
How your compliance officer reports to the Board could doom you. How often does your [...] - Audits:
Fraud Hammer Continues To Pound Home Care
OIG's latest report highlights HHA outliers, DME support surfaces. The feds have three billion good [...] - Industry Notes:
Home Infusion Could Save Medicare Money, GAO Says
Private sector insurance often opts for home infusion. Your non-homebound patient business could increase, if [...] - Industry Notes:
With Medicare's Recovery Audit Contractors and other fraud hunters turned loose
With Medicare's Recovery Audit Contractors and other fraud hunters turned loose thanks to health care [...] - Industry Notes:
Expect more scrutiny of your claims, thanks to President Obama directing HHS
Expect more scrutiny of your claims, thanks to President Obama directing HHS to cut Medicare's [...] - Industry Notes:
You may find Medicare appeals processes
You may find Medicare appeals processes a little more flexible under a new instruction from [...] - Industry Notes:
Don't expect a RAP payment
Don't expect a RAP payment if your patient has an open Medicare Secondary Payor record. [...] - Industry Notes:
Despite the home medical equipment
Despite the home medical equipment industry's best efforts, the Jan. 1 implementation date for competitive [...] - Industry Notes:
You won't see any big changes from
You won't see any big changes from RHHI Palmetto GBA as a result of its [...] - Industry Notes:
You can brush up on the basics
• You can brush up on the basics of signature requirements -- and avoid denials -- with [...] - Industry Notes:
Difficulty accessing hospice care isn't
Difficulty accessing hospice care isn't only a problem in this country. There is not enough [...]
