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Wayne van Halem

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.

Not so QIC

C2C launches demo to resolve claims at the second level of appeals, before they escalate to the ALJ

JACKSONVILLE, Fla. – Certain HME providers will now have a voice at Medicare’s second level of appeals as part of a new demonstration project.

Talking audits over cocktails


If there are any two words that are incompatible in the HME industry, it’s “audit” and “happy.” Except when they are combined for the Audit Happy Hour at Medtrade Spring in Las Vegas.

Boom times for van Halem


ATLANTA – The van Halem Group has nearly doubled in size, adding nine employees for a total of 20.

What’s more, the group plans to hire five to seven additional employees in the coming months, says President Wayne van Halem.

RACs are back


WASHINGTON – CMS announced last week that the recovery audit contractors (RACs) will restart some of their reviews, but industry stakeholders don’t expect any curveballs.

In brief: VGM and van Halem merge, Pride and Navitas partner


WATERLOO, Iowa – The VGM Group and The van Halem Group have merged, allowing the member services organization to offer “an array of mission-critical professional services” related to audits.

Clinical documentation: Look to LCDs for guidance

Q. How do I know what Medicare wants in the documentation?

A. It seems like what they want and expect changes on a regular basis; however, most of the products you bill for have a local coverage determination (LCD).

Clinical documentation: Use amendments carefully

Q. How do amendments to documentation work?

A. It’s interesting to see how the industry has changed regarding documentation.  When I first started consulting and would ask how many people were actively requesting documentation up front, not many would raise their hands.