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The slow-motion unraveling of New Mexico’s Medicaid crackdown (With Sound...
By Trip Jennings and Sylvia Ulloa, New Mexico In Depth | June 30, 2017 There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations...
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Do You Pay Your Billing Agent a Percentage of Claims? You May Be in Violation...
The Office of Inspector General (OIG) recently disseminated hundreds of recoupment letters to providers in New York who had percentage-based contracts with billing agents. OIG is seeking recoupment for...
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“Bye Felicia”– Closing Your Doors To a Skilled Nursing Facility May Not Be So...
There are more than 15,000 nursing homes across the country. Even as the elderly population balloons, more and more nursing homes are closing. The main reason is that Medicare covers little at a...
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Medicare/caid Fraud, Tattletails, and How To Self Disclose
On July 13, 2017, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced the Department of Justice’s (DOJ) biggest-ever health care fraud...
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Medicare Appeals Backlog: Is HHS In Danger of Being Held in Contempt?
Four months after the Center for Medicare and Medicaid Services’ (CMS) Final Rule went in effect (March 2017) attempting to eliminate the Medicare appeal backlog and 6 months before United States...
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The Reality of Prepayment Review and What To Do If You Are Tagged – You’re It!
Prepayment review is a drastic tool (more like a guillotine) that the federal and state governments via hired contractors review the documentation supporting services for Medicare and Medicaid prior to...
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“Ought Implies Can”– Court Reverses Decision Forcing HHS to Eliminate...
But all is not lost… it all lies in the possibility… A few weeks ago I blogged about Health and Human Services (HHS) possibly being held in contempt of court for violating an Order handed down on Dec....
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Knicole Emanuel Featured on Hospital Finance Podcast – Medicare Appeal...
On September 6, 2017, I appeared on the Besler Hospital Finance Podcast regarding: Update on the Medicare appeals backlog [PODCAST] Feel free to listen to the podcast, download it, and share with...
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Silence Can Be Deadly: Can You Be Held Responsible for Medicare/caid Billings...
You submit a claim for medically necessary services for a Medicaid recipient. Let’s say you provide behavioral health care services and prescribe medication for people who suffer from schizophrenia or...
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Medicare Audits – TPE Audits Are Here, But For How Long?
The Center for Medicare and Medicaid Services (CMS) announced the expansion of Targeted Probe and Educate (TPE) audits. At first glance, this appears to be fantastic news coming on the heels of so much...
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