Tag: The van Halem Group
Medicaid: Expect more scrutiny
April 12, 2019Theresa Flaherty, Managing Editor
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...
TPE program: Still a work in progress
January 11, 2019Liz Beaulieu, Editor
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,”...
Patients Over Paperwork: Room for improvement for HME
October 5, 2018Liz Beaulieu, Editor
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...
Don't gamble on your claims, van Halem Group says
April 23, 2018Theresa Flaherty, Managing Editor
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.
Originally launched as a pilot program in one MAC jurisdiction in 2016, the Targeted Probe and Educate program was expanded to all jurisdictions in October 2017.
“Reducing the provider burden is great—who doesn't want to reduce burdens,” said Wayne van Halem, president of The van Halem Group, during...
Industry appeals for 'common sense'
February 2, 2018Theresa Flaherty, Managing Editor
WASHINGTON - HME issues took center stage at the inaugural meeting of a new CMS focus group aimed at putting “Patients Over Paperwork.”The Provider Compliance Focus Group, which is expected to meet quarterly, discussed how reducing onerous regulations could help improve documentation compliance.“You can imagine we probably spoke up more than anyone else in the room,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “It's the same issues—we...
Vents: RACs join the party
January 26, 2018Theresa Flaherty, Managing Editor
WASHINGTON - The national recovery audit contractor for HME has set its sights on ventilators, but that's no big surprise, industry stakeholders say.
The Medicare Administrative Contractors are already auditing vents, and the Office of Inspector General has included the product category in past work plans.
“I think it's a no-brainer for the RACs to say, 'Hey let's audit this, too,'” said Kim Brummett, vice president of regulatory affairs for AAHomecare.
Performant...
van Halem Group gets HIPAAwise
August 23, 2017HME News Staff
ATLANTA - The van Halem Group, a division of The VGM Group, has finalized an agreement with HIPAAwise to exclusively offer its online HIPAA Compliance Program application to healthcare providers in the post-acute care market. The application creates a comprehensive dashboard for providers to manage their HIPAA compliance program, including their policies and procedures, security and risk assessment, business associate management, employee awareness programs, location and inventory tracking, and breach...
Improvements to the Adjudication Process of Serial Claims
June 26, 2017Guest Commentary
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...
Audits: Use two-tier approach
April 20, 2016Kelly Grahovac
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...
Audits: Get your strategy
March 21, 2016Kelly Grahovac
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...