The Details Matter

An audit and compliance newsletter

September 10, 2014
by VanHalem Group
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A Word from Wayne

wayne_vanhalemThe summer months have seen some big changes for The van Halem Group, the most notable being our merger with VGM Group. For years, our organizations worked collaboratively to help providers as they navigate the Medicare maze of audits and appeals. Continue Reading →

September 9, 2014
by VanHalem Group
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Audit Alerts

DAuditAlertsME contractors perform pre- and post-payment reviews on a continual basis. Through data analysis, the medical review department determines the codes it will review and then sends Additional Documentation Request (ADR) letters to suppliers that bill those codes. The following list includes those codes currently being reviewed in all four DME jurisdictions.

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September 9, 2014
by VanHalem Group
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The KX Modifier, Friend or Foe?

KXBy definition, when the KX modifier is added to a HCPCS code, the supplier is indicating to Medicare that all of the coverage criteria in the “Indications and Limitations of Coverage and or Medical Necessity” section of the LCD have been met and that the evidence of such is on file. Continue Reading →

September 9, 2014
by VanHalem Group
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Utilizing the Upgrade Policy

UtilizingUpgradePolicyAn upgrade is defined as an item that goes beyond what is medically necessary under Medicare’s coverage requirements. When billing an item that you know will not be paid in full because it does not meet the coverage criteria stated in the LCD, you can still receive partial payment if the claim is billed the appropriate upgrade modifier (GK or GL). Continue Reading →

June 11, 2014
by Admin
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VGM, The van Halem Group merge

WATERLOO, Iowa – The VGM Group and The van Halem Group have merged, allowing the member services organization to offer “an array of mission-critical professional services” related to audits.

“They are the recognized leader in the audit defense field and our members will benefit greatly from this association,” stated Van Miller, CEO and founder of VGM, in a press release.

The van Halem Group is now a division of VGM. Its headquarters will remain in Atlanta, and Wayne van Halem will continue on as president.

Read More at HME News

April 22, 2014
by Admin
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Medicare Paid Doctors Millions, Analysis Of Claims Database Shows

WASHINGTON (AP) — How is it that a few doctors take in millions of dollars from Medicare?

Explanations for Wednesday’s eye-popping numbers from Medicare’s massive claims database ranged from straightforward to what the government considers suspicious, as the medical world confronted a new era of scrutiny.

The long-sought release of Medicare data revealed just how much the program paid individual doctors in 2012. An analysis by The Associated Press found that a tiny group, 344 out of more than 825,000 doctors, received $3 million or more apiece — a threshold that raises eyebrows for the government’s own investigators. Overall, about 2 percent of clinicians accounted for one-fourth of payments.

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March 7, 2014
by Admin
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Don’t become complacent!

WASHINGTON – Industry stakeholders caution HME providers against putting too much stock in CMS’s announcement last week that it will not initiate new audits as it transitions to new recovery audit contractors (RACs).

“Essentially, this is common that a contractor slows down their new workload so they can finish it out before their contract ends,” said Wayne van Halem, president of The van Halem Group. “So, unfortunately for the DMEPOS industry, I believe it’s just the calm before the next storm.”

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January 25, 2014
by Admin
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Budget Deal Whacks Medicare Providers

WASHINGTON — It’s hard to discern in the budget deal announced Tuesday night, but the bulk of its deficit savings come from fresh cuts to Medicare providers.

Under the proposal announced by Rep. Paul Ryan (R-Wis.) and Sen. Patty Murray (D-Wash.), chairs of their chambers’ respective budget committees, lawmakers will replace about two-thirds of the hated automatic cuts under budget sequestration (totaling $63 billion) for this year and next, and cut the deficit by about $23 billion.

read more on Huffington Post