Tag: Kelly Grahovac

While the Office of Inspector General lays out seven elements for an effective compliance program, Kelly Grahovac, senior consultant at The van Halem Group, says providers should focus on doing a few really well to avoid spreading themselves too thin. HME News spoke to Grahovac, who is co-hosting the Medtrade session, “Your Most Important Profit Center is a Corporate Compliance Program,” about which components to focus on and what mistakes to avoid. HME News: What are the top three...

On March 13, 2020, the Trump Administration announced regulatory flexibilities to help health care providers and states to respond to and contain the spread of coronavirus. Included in the announcement was that CMS will activate blanket waivers in an effort to ease certain requirements and to prevent gaps in access.One of these waivers is to expand telehealth services. Under this new waiver, Medicare can pay for office, hospital and other visits furnished via telehealth across the country, including...

ATLANTA - With most security breaches affecting small- and medium-sized businesses—not the Targets of the world—HME providers can't afford not to prioritize cybersecurity, said speaker Carol Albaugh.Providers are doing business in an environment where health care recently surpassed finance as the industry most targeted by hackers, said Albaugh, a technical solutions consultant at VGM.“It's so rich in the kind of data that hackers are looking to sell on the black market,” she...

YARMOUTH, Maine - Nearly two years after Performant Recovery announced it would perform an underpayment review for Group 3 power wheelchair options, providers are receiving refund checks, says Andrea Stark.Performant, the DMEPOS RAC, announced in May 2017 it would review wheelchair accessories, including seating systems, and seat and back cushions furnished in conjunction with codes K0848—K0864 for the six-month period of Jan. 1, 2016—June 30, 2016. The review was necessary because CMS...

YARMOUTH, Maine - With the Office of Inspector General and other government agencies regularly issuing reports on Medicaid overpayment issues, it's no surprise that audits are increasing, says Kelly Grahovac.An OIG report released in March found that Medicaid Fraud Control Units recovered nearly $14.9 million against DMEPOS suppliers in 2018.“We have seen an uptick in audits,” said Grahovac, senior consultant for The van Halem Group. “I think there's just more pressure across the...

WASHINGTON - CMS has updated its “Targeted Probe and Educate” program in two ways that could potentially make it easier and more fair for HME providers.The agency on Dec. 31 implemented the “TPE 10-Claim Preview Pilot” to allow the MACs to select just 10 claims for review under Round 1. If a provider is found to be compliant, the NPI associated with those claims will be exempt from reviews for about one year for those services/items.“In some ways it's good,” said...

WASHINGTON - Much has been made of CMS's plans to reduce the paperwork burden for healthcare providers, but what about for HME providers, specifically?The agency's most recent attempt was last month, when it released a proposed rule aimed at removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements. The rule, however, focused on Part A.“There was nothing in the rule for us,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “We...

A major win for DME suppliers was announced recently, as CMS released information regarding improvements to the adjudication process of serial claims. Effective April 7, 2017, CMS has implemented changes to improve the processing and adjudication of recurring (monthly) claims for capped rental and certain inexpensive and routinely purchased (IRP) items.Prior to April 2017, if a monthly rental claim was denied and then appealed separately, then the claim was adjudicated independently and without reference...

A. To reduce or remove the extrapolation, you will need to appeal the overpayment determination, addressing both the individual claims reviewed in the audit and the extrapolation itself. Consider this a two-tier appeal process. First you want to appeal each claim that was denied in the audit. Specifically address the denial provided by the auditor. When applicable, obtain amendments or attestations. The goal is to have the denied claims overturned, as this will result in a reduction in the error...

A. From the moment an audit letter lands in your mailbox, to the day the files are organized and ready to go out the door, it is important to have an audit response strategy. Establishing a step-by-step process will ensure timelines are met and all the necessary documentation is included in your response. It may also be beneficial to designate an individual to be responsible for the audit responses. The steps below are a good framework to get started.• Read the request carefully and identify the...