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Tag: Wayne van Halem


On the Editor's Desk

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...

Administrative Law Judge, Josh Britten, Medicare appeals, Wayne van Halem


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Speaker Q&A: Get paid the first time

Medtrade

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,...

Home Medical Equipment, Medtrade West 2022, Sarah Hanna, Wayne van Halem


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ALJ backlog: Providers will have ‘fighting chance’ again

News

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...

ALJ, Audits, Home Medical Equipment, van Halem Group, Wayne van Halem


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Navigating lead generation safely

Specialty Providers

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...

Lead generation, Orthotics, Round 2021, Wayne van Halem


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News

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...

Coronavirus Outbreak, Home Medical Equipment, Wayne van Halem


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Also Noted

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 to...

Board of Directors, FODAC, Wayne van Halem


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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...

Home Medical Equipment, Sylvia Toscano, Wayne van Halem


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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 administrative law judge or ALJ.Instead...

Audits, Managed Care, Wayne van Halem


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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...

HIPAA, OCR, Wayne van Halem


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Editorial

Is TPE really as easy as 1,2,3?

September 24, 2018Guest Commentary

As you are likely well aware by now, Medicare has transitioned away from widespread prepayment review and is now full speed ahead on their Targeted Probe and Educate (TPE) audit program. The key word here being “targeted.” The widespread medical review audits were previously focused on procedure codes and not necessarily on providers. Anyone submitting claims for codes under review were subject to prepayment audits. Now, they pick specific suppliers to focus their audit efforts on based...

Targeted Probe and Educate, TPE, Wayne van Halem


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