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Tag: The van Halem Group


News

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 across the...

Kelly Grahovac, Medicaid audits, The van Halem Group


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News

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,” said...

Kelly Grahovac, Targeted Probe and Educate, The van Halem Group, TPE audits


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News

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...

aahomecare, Kelly Grahovac, kim brummett, The van Halem Group


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Providers

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 his Medtrade...

The van Halem Group, TPE, Wayne van Halem


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News

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...

aahomecare, Home Medical Equipment, Patients Over Paperwork, The van Halem Group


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Specialty Providers

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 Recovery announced in January...

aahomecare, non-invasive ventilators, RAC audits, The van Halem Group, ventilator


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Also Noted

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...

compliance, Partnership, The van Halem Group, The VGM Group


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Editorial

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...

Kelly Grahovac, serial claims, The van Halem Group


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News

Are you RAC ready?

April 24, 2017Liz Beaulieu, Editor

Since it's been so long since HME providers have had to grapple with a RAC, stakeholders offered these pieces of advice:Be proactive. “Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the...

Andrea Stark, MiraVista, RAC audits, The van Halem Group, The VGM Group


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Smart Talk

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, Kelly Grahovac, The van Halem Group


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