Keys to a Successful Compliance Program
- Jeffrey S. Baird, JD
AMARILLO, TX - The laws and regulations governing health care providers in the United States are staggering. more »

Avoiding Pitfalls: What the ZPICs, AOs, NSC, and OIG are Looking For
- Jeffrey S. Baird, JD
HME providers are in a figurative “house of mirrors" — constantly being looked at from a variety of angles. more »

Consignment Closets and Employee Liaisons
- Jeffrey S. Baird, JD
AMARILLO, TX - An HME company can pay rent to a facility, so long as the rental agreement complies with the Space Rental safe harbor to the Medicare anti-kickback statute. more »

Pharmacists Feeling Audit Pain
WASHINGTON, DC - Officials at the NCPA characterized the audit climate as “abusive” in language that sounds a lot like home care complaints. more »

Honest Mistake Leads to Misery for NY Provider
- Greg Thompson
RIVERHEAD, NY - Leroy Lewin and his wife have quietly run a successful HME company since 1984. In March 2012, the business nearly came to a halt. more »

Solicitation Concerns Addressed by CMS
WASHINGTON, DC - A CMS final rule has removed the definition of "direct solicitation." more »

Dozen Days and Counting
- Greg Thompson
HIGH POINT, NC - With 12 days left to bid on round two of DMEPOS competitive bidding, round one survivor Kim Brummett implores: “Be smart. Don’t bid to win and lose money.” more »

CMS Redesigns Claims and Benefits Statement
WASHINGTON, DC - Medicare beneficiaries will reportedly have an easier time reviewing claims thanks to the new Medicare Summary Notice (MSN). Plus: CMS to brief Senate staff on competitive bidding. more »

Baird: "I'm Sounding a Warning"
- Jeffrey S. Baird, JD
AMARILLO, TX - I am sounding a warning. The government, like a laser, is focusing on HME providers who purchase leads. more »

EHR Adoption Growing, But Meaningful Use Still Elusive
STAMFORD, CT – 42% of health care providers surveyed currently use either EHRs or EMRs, but 39% have no plans to implement stage one of so-called “meaningful use.” more »

Anti-Fraud Statutes Not Limited to Medicare: States Have Their Own Statutes
- Todd A. Moody, JD
AMARILLO, TX - HME providers who enter into an arrangement with a referral source in which patients (covered by a government health care program) are not involved, they should not become complacent. more »

Licensure Deadline Extension for Round Two of Competitive Bidding
WASHINGTON, DC - CMS is extending the DMEPOS licensure deadline for round two of competitive bidding. more »

VGM Issues Credit Report Clarification
WATERLOO, IOWA - Must potential round two bidding companies have a credit report dated before January 30? The answer is no, according to a recent clarification. more »

Selling Items for Cash at a Price Less Than the Medicare Allowable
- Jeffrey S. Baird, JD
AMARILLO, TX - Because of the cost savings resulting in not having to submit claims to Medicare, HME companies price cash products less than the Medicare allowable for the same items. more »

CMS Will Modify Oxygen Audit Process
WASHINGTON, DC - After a year of suffocating audits for many providers, the DME MACs indicated last week that changes were on the way. more »

Evaluating Bids Through the Eyes of the CBIC
- Todd Moody, JD
AMARILLO, TX - Understanding how the CBIC evaluates bids and awards contracts reads like The Da Vinci Code—in Latin. more »

2012 OIG Work Plan: What it Means for Providers
- Jeffrey S. Baird, JD
AMARILLO, TX - The OIG will also look at the extent to which CMS and its contractors participate in ALJ hearings. This is troublesome. more »

Medicare Audits Continue to Plague Providers

WASHINGTON, DC - An unprecedented blitz goes on as Medicare contractors continue to boost audit activity in the wake of CMS’ announcement that 2011 has so far yielded a 61% Medicare error rate for HME. more »

Competitive Bidding Schedule is Out: Now What?
- Jeffrey S. Baird, JD
AMARILLO, TX - Seven steps for survival in a new reality. more »

More Than 100,000 PCPs Sign On for EHRs
WASHINGTON, DC - Primary care physicians (PCPs) are converting to electronic health records (EHRs) to the tune of more than 100,000, according to an announcement last week from HHS. more »

State Medicaid Audits and Investigations: The New Alpha Dog
- Jeffrey S. Baird, JD
AMARILLO, TX - HME providers who bill their state Medicaid program must be just as vigilant in understanding (and adhering) to state Medicaid regulations as they do with Medicare regulations. more »

“Unprecedented” Audit Climate Dominates Conversation at Medtrade
ATLANTA - Joe Lewarski heard a lot of interesting things at Medtrade, but the audit situation surprised him the most. more »

Part B Premiums and Deductible Lower Than Expected
WASHINGTON, DC - HHS predicted last week that 2012 Medicare Part B premiums and deductible will be lower than previously projected. more »

Advisory Opinion Requests Not Limited to OIG
AMARILLO, TX - Providers can submit request for advisory opinions to the OIG, but not everyone knows there is a parallel procedure involving CMS. more »

Baird: Meet Round Two State Requirements
AMARILLO, TX - Particularly for providers who desire to submit bids in multiple CBAs, matters become more complicated. more »

Medicare Open Enrollment Expanded
WASHINGTON, DC - CMS began Medicare Open Enrollment for beneficiaries 2 days ago (Oct 15), adding an additional 7 weeks to the process which will end on Dec 7. more »

Blackburn: Government Playing “Russian Roulette” With Diabetes Patients
TARENTUM, PA - HME providers are not the only ones anticipating the negative consequences of competitive bidding. More than 800 independent community pharmacists fear that applying competitive bidding prices for diabetes testing supplies will be financially unsustainable and harmful to seniors. more »

Baird: Extra Scrutiny Creating Challenges
AMARILLO, TX - NSC inspectors are asking questions these days that go beyond the ordinary, and Jeffrey S. Baird, JD, says provider awareness must be high. more »

Don’t Forget About Revalidation
WASHINGTON, DC - CMS will hold a national provider call on Thursday, Oct 27, from 12:30 p.m. - 2:00 p.m., to discuss the revalidation of Medicare provider enrollment information. more »

Competitive Bidding: Muffins, Hope, and Reality
- Greg Thompson
WASHINGTON, DC - Overpriced muffins provided an unexpected competitive bidding lesson while legislator sympathy seemed to go the industry’s way during the past week. Denial among providers, however, is still a problem. more »

Fraud Crackdown Yielding Convictions
MIAMI - Two South Florida residents pleaded guilty in U.S. District Court last week for their participation in a $25 million home health Medicare fraud scheme. more »

Fraud Taint Spreads Again
WASHINGTON - South Florida plunged back into the fraud spotlight in September when Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius touted new Medicare fraud crackdowns totaling $295 million in false billings. more »