Uncategorized
Medicare, Medicaid & Payer Audit Requests Payers are auditing claims at an increasing rate. Be prepared! Have a process
Medicare, Medicaid & Payer Audit Requests Payers are auditing claims at an increasing rate. Be prepared! Have a process to ensure the packets are reviewed and completed before submission. Here are a few tips to stay prepared: Attach copies when you bill a code Monitor the time frame it takes to gather records You CAN…
Read MoreCMS audit and claw back of $2 Billion denied by federal master.
A federal judicial master’s critique of CMS’ audit case against a health insurer, “A mere possibility of an overpayment is not enough for the government to carry its burden.” The problem with the government’s allegations is that the government knew of the very chart review practices which it now claims United prevented it from learning,…
Read MoreCMS/Cardinal Health, Novitas Improper Audits and Claw Backs
I represent many health care providers. I also represent health care businesses respond to CMS, Cardinal Health and or Novitas Solutions improper medicare medicaid audits and claw backs. My clients email me these audit letters that are generated through AI data dumping and crunching. This process is authorized through the federal OIG regulations that give…
Read MorePennsylvania’s Updated Use of Prior Criminal Records In Licensing Decisions
On June 24 2020, the General Assembly enacted Senate Bill 637 which reforms occupational licensing by getting rid of outdated criminal record restrictions for the professions and occupations which are regulated by boards and commissions within the Bureau of Professional and Occupational Affairs (BPOA). Prior state law perpetuated racial disparities in arrests in the…
Read MoreState Board of Nursing: Additional Temporary: License Renewal Waivers
March 27, 2020 State Board of Nursing: Additional Temporary Waivers Summary: The Department of State’s Bureau of Professional and Occupational Affairs (BPOA) requested, and Governor Wolf granted, waivers to several regulatory/statutory provisions related to the State Board of Nursing for the duration of the COVID-19 emergency. For Certified Registered Nurse Practitioners (CRNPs): CRNPs…
Read More