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Wayne van Halem

RAC to perform rare underpayment review

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05/18/2017

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

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01/27/2017

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
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11/18/2016

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

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04/15/2016

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
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03/11/2016

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

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01/22/2016

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

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01/23/2015

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

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08/08/2014

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

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06/13/2014

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?
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05/28/2014

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).

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