The Details Matter

An audit and compliance newsletter

January 7, 2015
by VanHalem Group
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Compliance Corner – January 2015

compliance-corner-imageWith the implementation of the Affordable Care Act, the government has been given greater authority to enforce compliance and address fraud, waste and abuse. As noted in our last newsletter, the ACA mandates Compliance Programs as a condition of enrollment in Medicare, Medicaid and CHIP.   Even more compliance efforts under the ACA and Medicare enrollment are being empowered by CMS.

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January 7, 2015
by VanHalem Group
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Audit Alerts

audit-alert-imageDME contractors perform pre- and post-payment reviews on a continual basis. Through data analysis, the medical review department determines the codes they will review and then sends Additional Documentation Request letters to suppliers that bill those codes.

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January 7, 2015
by VanHalem Group
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OIG Work Plan 2015

oig-work-plan-imageThe Office of the Inspector General develops a work plan that summarizes new and ongoing reviews they plan to pursue during the current fiscal year. While the OIG conducts reviews with respect to all HHS programs, nearly 76 percent of their funding is dedicated toward oversight of the Medicare and Medicaid programs. Specifically, the organization was created to protect HHS programs by detecting fraud, waste and abuse.

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January 7, 2015
by VanHalem Group
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RAC Update

rac-update-imageOn December 30, 2014, the CMS announced that the National DMEPOS and Home Health & Hospice Recovery Audit contract had been awarded to Connolly, LLC. Connolly is no stranger to the RAC game, as they were previously the Region C Recovery Audit Contractor.

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January 7, 2015
by VanHalem Group
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A Word from Wayne – January 2015

We are looking forward to 2015.  As we are closing the year, we see our team growing with additional resources for our clients – both in technology and manpower.  We are in the final stages of implementing an automated audit and appeal tracking system in conjunction with MedFORCE Technologies to offer a complete solution for our clients.

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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 →