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Wayne van Halem

Auditors avoid appeals process, make ‘major’ requests


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.

HIPAA compliance: Providers have homework to do


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.

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


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.

Don’t gamble on your claims, van Halem Group says


LAS VEGAS – Although Medicare is attempting to reduce claim denials and appeals with a “friendlier” process, HME providers still need to take that process seriously.

Settlement update: A non-option option for appeals


WASHINGTON – CMS has rolled out a new settlement option for low-volume appeals, but it’s not likely HME providers will take the agency up on its offer, stakeholders say.

HME: Not so hip on HIPAA?

‘The No. 1 focus of audits is the security and risk assessment, which is woefully missing in this industry’

ATLANTA – Industry consultants report a number of HIPAA-related audits making the rounds in the HME industry and the best they can tell, providers, for the most part, are not prepared for them.

RAC to perform rare underpayment review


ATLANTA – Performant Recovery, the DMEPOS RAC, will perform an underpayment review for Group 3 power wheelchair options. The Patient Access and Medicare Protection Act mandates that adjustments to the 2016 Medicare fee schedule amounts for certain DME based on information from the competitive bidding program cannot be applied to wheelchair accessories, including seating systems, and seat and back cushions furnished in connection with codes K0848—K0864. The change was effective Jan. 1, 2016 but CMS was unable to implement changes to its processing systems until July 1 2016. Payments during that time were based on adjusted fee schedule amounts. “DME suppliers rarely experience RAC underpayments, so this is a welcome change,” said Wayne van Halem, president of The van Halem Group, a division of the VGM Group. “Many folks don’t know this, but the RACs are funded to find underpayments, in addition to overpayments and in this environment, every little bit helps.”

Expect audits to get more aggressive


atlanta – When ZPIC auditors come calling, it’s important not to throw up your hands in surrender because there’s too much at stake, said healthcare attorney Ross Burris.

Providers prep for return of RAC

New contract, however, means several improvements to process

LIVERMORE, Calif. – Providers should strap in: After a protracted lull, RAC audits will likely pick back up in January, now that CMS has tapped Performant Recovery, based here, to perform post-payment reviews for DME and home health/hospice claims nationwide.

Regulatory review: Suspensions, overpayments and exemptions


WASHINGTON – From a regulatory perspective, the first several months of 2016 have brought pain, and a little bit of relief, to HME providers.