Articles and Blogs

The Centers for Medicare & Medicaid Services (“CMS”) has made changes to the Medicare Overpayment Notification Process.  If an outstanding balance has not been resolved, providers previously received three notification letters regarding the overpayments:  (1) an initial demand letter, (2) a follow-up letter, and then (3) an intent to refer letter.  CMS would send the second... READ MORE

The Centers for Medicare & Medicaid Services (“CMS”) has reevaluated the revalidation requirements in the Affordable Care Act (“ACA”), and believe the ACA allows for the extension of the revalidation period for an additional two years.  This will extend the deadline for revalidation through March of 2015.  Providers are reminded that if they have... READ MORE

The Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Round 2 and the national mail-order competitions are coming soon. Though the bidding schedule has not yet been released, suppliers interested in bidding should begin their preparations now to help avoid unnecessary delays or rejection of a bid application. Any supplier who... READ MORE

On October 31, 2011, the final rule (Rule) to update the Home Health Prospective Payment System (HH PPS) for Calendar Year 2012 was published in the Federal Register.  As a result of the Centers for Medicare & Medicaid Services (CMS) implementing the Rule, home health agencies (HHAs) will experience a decrease in payments of... READ MORE

Pursuant to Section 6111 of the Affordable Care Act enacted on March 23, 2010, and the final rule published on March 18, 2011 in the Federal Register, a nursing facility must be offered the opportunity to request an Independent Informal Dispute Resolution (IIDR) if the Centers for Medicare & Medicaid Services (CMS) imposes a... READ MORE

CMS has just released the highly anticipated final regulations for accountable care organizations (ACOs) under Section 3022 of the Affordable Care Act (ACA).  The ACA requires accountable-care agreements to be offered under Medicare, starting in 2012.  READ MORE

Just weeks after ongoing development of the CLASS Act stalled, Secretary Sebelius announced today the implementation of the CLASS Act has been completely halted.  Reflecting concerns over the sustainability of the program and the potential for the development of a new entitlement program, the Department of Health and Human Services determined the financing plans related to the Act... READ MORE

On October 12, 2011, the U.S. Department of Justice unsealed an indictment charging Matthew Kolodesh a/k/a Matvei Kolodech, with conspiracy to defraud Medicare of more than $14 million.  According to the indictment, Kolodesh’s business, Home Care Hospice, Inc. (HCH), located in Philadelphia, PA, submitted Medicare claims for approximately $14.3 million dollars for patients who... READ MORE

As previously discussed, hospice providers are required to have a hospice physician or nurse practitioner perform a face-to-face encounter with each hospice patient whose total length of stay is anticipated to reach the third benefit period.  This encounter must be performed no more than thirty days prior to the third benefit period recertification, and... READ MORE

On October 5, 2011, the Office of Inspector General (OIG) published its proposed Work Plan for Fiscal Year 2012. As in the past, the Work Plan continues to identify compliance risk areas that subject Medicare and Medicaid providers to audit and enforcement initiatives. The 2012 Work Plan contains several new areas of focus by... READ MORE