Tag: Kelly Wolfe

TAMPA, Fla. – Kelly Wolfe, president of Regency Inc., a medical billing company, has agreed to plead guilty to criminal health care and tax fraud, and to pay $20.3 million in a civil False Claims Act settlement.  Wolfe, of Indian Rocks Beach, Fla., faces a maximum penalty of 13 years in federal prison.  Wolfe and her conspirators used Regency to establish dozens of DME shell companies, placing the shell companies in the names of straw...

A. One of the accreditation requirements is to have and maintain a performance management plan. Although providers provide this documentation at the initial accreditation survey, many fail to implement it after the survey. This is an important factor and requirement to maintain your accreditation. This is also a valuable tool to help your company correct issues and make you shine above the competition.Your performance management plan should measure billing practices, adverse events and consumer services....

A. DME accreditation needs to be renewed every three years. With the initial accreditation most DME supplies take the time to prepare and get ready for the survey. Many hire the expertise of a consultant and sweat it out waiting for the site survey. They spend hours preparing to make sure they will pass. They have a policy and procedure manual, forms, and knowledge they learned during the process.It is expected that you are following all the standards and adhering to the policies you have in place....

A. 2019 is a big year for the HME industry when it comes to accreditation renewals and adding product categories to your line of business. Many providers are considering adding new lines of business since the lifting of competitive bidding until January of 2021. Please make sure and be aware that any item you decide to provide needs to be updated with not only your accrediting body but the National Supplier Clearinghouse as well.  If you are in a state that has licensure, you may need to do...

INDIANAPOLIS - Few providers in Jurisdiction B seem to be affected so far by a recent prepayment review for manual wheelchair bases, including the adult tilt-in-space models, coded E1161.“We have so many audits, we can't tell one from the other,” said billing consultant Sylvia Toscano, owner of Professional Medical Administrators. “We don't have a lot of people billing E1161 in Region B since they changed it to a rental, so I don't think we're doing as many as we used to. It's...

For years, HME providers have been trying to teach physicians what they need to include in their chart notes, often to no avail, says Sarah Hanna, president of ECS Billing & Consulting North.But the transition to ICD-10 may be the thing that finally gets through to them, she says.“How a physician gets paid corresponds to a diagnosis procedure code,” she said. “Well guess what, to prove medical necessity for an ICD-10 code, which is more specific, you have to chart in a way that...

It's no secret that providers have historically shied away from going after beneficiaries who are slow to pay, but in an environment where every dollar counts that's changing, say consultants. Here, they offer a few basic—and practically free—tips to help providers get what they are owed.Be upfrontLet the beneficiary know before they walk out the door how much he or she is going to have to pay, says consultant Kelly Wolfe.“The providers I see have a good return rate if they just...

YARMOUTH, Maine - When provider Tammy Zelenko gets ready to close the books on her fiscal year every June, she strives to close out outstanding patient balances.Sometimes, that means offering a discount to patients to get them to pay up.“You'll do whatever it takes to get that money,” said Zelenko, CEO of AdvaCare Home Services in Bridgeville, Pa. “It's better than ending up writing it off or sending them to collections.”With more patients paying out of pocket for needed home...

The implementation date for ICD-10 may have been delayed until at least Oct. 1, 2015, but the transition to the new code set, when it does happen, will still likely muck up the process for HME, industry consultants say.The biggest misconception that providers have about ICD-10, they say: that there will always be an easy, one-to-one transition from ICD-9 to ICD-10.“If we think we can just pick a code in the crosswalk, we can't,” said Sarah Hanna, president of ECS Billing & Consulting...

WASHINGTON - CMS has set a new start date for denying DME claims with the names of physicians who are not enrolled in PECOS and, this time, it may stick, industry stakeholders say.Starting on Jan. 6, 2014, claims with the names of physicians who are not enrolled in PECOS will be denied, and the provider who submitted the claims will not be paid for the items or services that were furnished. Most recently, CMS had planned to start denying claims on May 1, 2013.“It feels real this time,”...