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Tag: Kelly Grahovac


Guest Blog

Relaxed HIPAA requirements for telehealth encounters during the COVID-19 national emergency

March 22, 2020HME News Staff

On March 13, 2020, the Trump Administration announced regulatory flexibilities to help health care providers and states to respond to and contain the spread of coronavirus. Included in the announcement was that CMS will activate blanket waivers in an effort to ease certain requirements and to prevent gaps in access.One of these waivers is to expand telehealth services. Under this new waiver, Medicare can pay for office, hospital and other visits furnished via telehealth across the country, including...

coronavirus outbreak, Kelly Grahovac, telehealth, van Halem Group


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Medtrade Show Daily

Cybersecurity and compliance: Big problems for smaller companies

October 22, 2019Liz Beaulieu, Editor

ATLANTA - With most security breaches affecting small- and medium-sized businesses—not the Targets of the world—HME providers can't afford not to prioritize cybersecurity, said speaker Carol Albaugh.Providers are doing business in an environment where health care recently surpassed finance as the industry most targeted by hackers, said Albaugh, a technical solutions consultant at VGM.“It's so rich in the kind of data that hackers are looking to sell on the black market,” she...

Carol Albaugh, cybersecurity, Kelly Grahovac, Medtrade 2019


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News

Audit round up: RACs cut checks, UPICs run roughshod

June 28, 2019Theresa Flaherty, Managing Editor

YARMOUTH, Maine - Nearly two years after Performant Recovery announced it would perform an underpayment review for Group 3 power wheelchair options, providers are receiving refund checks, says Andrea Stark.Performant, the DMEPOS RAC, announced in May 2017 it would review wheelchair accessories, including seating systems, and seat and back cushions furnished in conjunction with codes K0848—K0864 for the six-month period of Jan. 1, 2016—June 30, 2016. The review was necessary because CMS...

Andrea Stark, Elizabeth Hogue, Kelly Grahovac, Performant Recovery, RAC, UPIC


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News

Medicaid: Expect more scrutiny

April 12, 2019Theresa Flaherty, Managing Editor

YARMOUTH, Maine - With the Office of Inspector General and other government agencies regularly issuing reports on Medicaid overpayment issues, it's no surprise that audits are increasing, says Kelly Grahovac.An OIG report released in March found that Medicaid Fraud Control Units recovered nearly $14.9 million against DMEPOS suppliers in 2018.“We have seen an uptick in audits,” said Grahovac, senior consultant for The van Halem Group. “I think there's just more pressure across the...

Kelly Grahovac, Medicaid audits, The van Halem Group


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News

TPE program: Still a work in progress

January 11, 2019Liz Beaulieu, Editor

WASHINGTON - CMS has updated its “Targeted Probe and Educate” program in two ways that could potentially make it easier and more fair for HME providers.The agency on Dec. 31 implemented the “TPE 10-Claim Preview Pilot” to allow the MACs to select just 10 claims for review under Round 1. If a provider is found to be compliant, the NPI associated with those claims will be exempt from reviews for about one year for those services/items.“In some ways it's good,” said...

Kelly Grahovac, Targeted Probe and Educate, The van Halem Group, TPE audits


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News

Patients Over Paperwork: Room for improvement for HME

October 5, 2018Liz Beaulieu, Editor

WASHINGTON - Much has been made of CMS's plans to reduce the paperwork burden for healthcare providers, but what about for HME providers, specifically?The agency's most recent attempt was last month, when it released a proposed rule aimed at removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements. The rule, however, focused on Part A.“There was nothing in the rule for us,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “We...

aahomecare, Kelly Grahovac, kim brummett, The van Halem Group


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Editorial

Improvements to the Adjudication Process of Serial Claims

June 26, 2017Guest Commentary

A major win for DME suppliers was announced recently, as CMS released information regarding improvements to the adjudication process of serial claims. Effective April 7, 2017, CMS has implemented changes to improve the processing and adjudication of recurring (monthly) claims for capped rental and certain inexpensive and routinely purchased (IRP) items.Prior to April 2017, if a monthly rental claim was denied and then appealed separately, then the claim was adjudicated independently and without reference...

Kelly Grahovac, serial claims, The van Halem Group


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Smart Talk

Audits: Use two-tier approach

April 20, 2016Kelly Grahovac

A. To reduce or remove the extrapolation, you will need to appeal the overpayment determination, addressing both the individual claims reviewed in the audit and the extrapolation itself. Consider this a two-tier appeal process. First you want to appeal each claim that was denied in the audit. Specifically address the denial provided by the auditor. When applicable, obtain amendments or attestations. The goal is to have the denied claims overturned, as this will result in a reduction in the error...

audits, Kelly Grahovac, The van Halem Group


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Smart Talk

Audits: Get your strategy

March 21, 2016Kelly Grahovac

A. From the moment an audit letter lands in your mailbox, to the day the files are organized and ready to go out the door, it is important to have an audit response strategy. Establishing a step-by-step process will ensure timelines are met and all the necessary documentation is included in your response. It may also be beneficial to designate an individual to be responsible for the audit responses. The steps below are a good framework to get started.• Read the request carefully and identify the...

audits, Kelly Grahovac, The van Halem Group


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Smart Talk

Audits: Be a bit of a sleuth

February 22, 2016Kelly Grahovac

A. Believe it or not, you don't have to be a fortune teller to predict what Medicare and its auditors have on their radar, but being a bit of a sleuth won't hurt. Let me explain.Some audit contractors make it simple by publishing the types of DMEPOS they intend to audit on their websites. The RACs, for example, can only perform post-payment audits on codes approved by CMS. Once CMS has approved the codes, the RAC will post the information to their website in the “Approved Issues” table....

audits, Kelly Grahovac, The van Halem Group


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