Tag: Wayne van Halem
Managed care: Don’t give into ‘extortion’
March 27, 2024Theresa Flaherty, Managing Editor
DALLAS – Managed care plans have gotten a lot more active in auditing and, unfortunately, for providers they often operate under their own playbook, Wayne van Halem told Medtrade attendees on Tuesday.
One thing, in particular, that he’s seeing: an increase in extrapolated overpayments, which are supposed to be appealable, but the plans don’t seem to understand that, he said.
“What they’re doing is extortion: Pay this (extrapolated overpayment) or we’re...
To be continued ...
March 17, 2022Liz Beaulieu, Editor
When we included a Q&A with Josh Britten in our HME Newswire in February, I wasn’t surprised it resonated with readers.
Britten, CEO of BritKare Home Medical, shared his battle to get back nearly $650,000 in denied Medicare claims – a battle that took him six years and more than $100,000 in legal and consultant fees.
One provider responded to the story on Twitter by writing: “When you incentivize claims denial as a means of revenue generation you will find reasons to deny...
Speaker Q&A: Get paid the first time
February 28, 2022Tracy Orzel
PHOENIX - While respiratory products may be spared in the short term, audit activity is increasing overall, says Wayne van Halem, president of The van Halem Group. Here’s what session co-hosts van Halem and Sarah Hanna, CEO of ECS North, have to say about what to expect in 2022 and how to get paid the first time.
HME News: What is the state of audits right now?
Wayne van Halem: The biggest thing I see on the horizon is that the ALJ backlog will be resolved probably mid-2022,...
ALJ backlog: Providers will have ‘fighting chance’ again
February 18, 2022Liz Beaulieu, Editor
ATLANTA – The Office of Medicare Hearings and Appeals should be caught up on a years-long backlog of appeals at the administrative law judge (ALJ) level sometime this summer, predicts Wayne van Halem, president of the van Halem Group.
That means OMHA should be back to holding hearings at the ALJ level within 90 days as required by law, he says.
“The appeals process has to be timely,” he said. “If the appeals process is timely and Medicare has to hold off...
Navigating lead generation safely
December 29, 2020Theresa Flaherty, Managing Editor
ATLANTA - Wayne van Halem gets contacted “all the time” by companies that are having issues with audits. A common factor? Lead-generating companies, he says.
These are companies that are new to the industry and those that are well established, he says.
“They will convince people that they can make them a lot of money,” said van Halem, president of The van Halem Group. “They get told, ‘We’ll do all the work and the paperwork, and all you have to do is...
Gov't officials warn about coronavirus-related fraud
June 1, 2020Liz Beaulieu, Editor
ATLANTA - The government is already seeing fraudulent scams related to the coronavirus pandemic, says Wayne van Halem, including, unfortunately, a scam involving DMEPOS.van Halem, an Accredited Healthcare Fraud Investigator and Certified Fraud Examiner, recently participated in a webinar hosted by the National Healthcare Anti-fraud Association, during which special agents from the Office of Inspector General/Office of Investigations reported Medicare beneficiaries are being told in unsolicited phone...
FODAC names van Halem to board
March 25, 2020HME News Staff
TUCKER, Ga. - Friends of Disabled Adults and Children, a nonprofit organization providing more than $10 million annually in DME and supplies to those disabilities, has added Wayne van Halem to its board of directors. van Halem is president of the Atlanta-based The van Halem Group, a national consulting firm that counsels clients on applicable laws and regulations related to Medicare and other payers. “Wayne's extensive experience in regulatory issues and compliance, specifically related...
Auditors avoid appeals process, make 'major' requests
November 27, 2019Liz Beaulieu, Editor
YARMOUTH, Maine - If you're an HME provider trying to appeal a denial by a managed care payer, it's probably not going very smoothly, reports consultant Wayne van Halem.“There's a process for appeals they have to follow that's outlined in the managed care manual and they're not doing that,” said van Halem, president of the van Halem Group.The process is similar to Medicare's: a number of levels of appeals, including redetermination, reconsideration and administrative law judge or ALJ.Instead...
Auditors avoid appeals process, make 'major' requests
September 13, 2019Liz Beaulieu, Editor
YARMOUTH, Maine - If you're an HME provider trying to appeal a denial by a managed care payer, it's probably not going very smoothly, reports consultant Wayne van Halem.
“There's a process for appeals they have to follow that's outlined in the managed care manual and they're not doing that,” said van Halem, president of the van Halem Group.
The process is similar to Medicare's: a number of levels of appeals, including redetermination, reconsideration and...
HIPAA compliance: Providers have homework to do
November 20, 2018Liz Beaulieu, Editor
WASHINGTON - The finding that zero of the “covered entities” recently audited by the Office of Civil Rights fully complied with HIPAA requirements is a “wake-up call” for HME providers, says Wayne van Halem.What's more, the OCR found that more than 80% of “covered entities” made minimal, negligible or no efforts to comply with the requirements.“Our industry is really vulnerable here,” said van Halem, president of The van Halem Group, a division...