Tag: van Halem Group

ATLANTA – The Office of Medicare Hearings and Appeals should be caught up on a years-long backlog of appeals at the administrative law judge (ALJ) level sometime this summer, predicts Wayne van Halem, president of the van Halem Group.   That means OMHA should be back to holding hearings at the ALJ level within 90 days as required by law, he says.  “The appeals process has to be timely,” he said. “If the appeals process is timely and Medicare has to hold off...

ATLANTA – The van Halem Group has announced that Dr. Doran Edwards has joined its team as a medical advisor. Edwards recently retired after three years with Palmetto GBA, where he was the medical director for the Pricing, Data Analysis and Coding contractor. He was also the medical director of the SADMERC, the predecessor to the PDAC from 2003-08. “Over the last few years, the van Halem Group has been working with manufacturers as they bring new products to market and need to navigate...

WATERLOO, Iowa – Wayne van Halem and Kelly Grahovac of The van Halem Group have joined state association boards. van Halem, president, was named to the board of the Georgia Association of Medical Equipment Suppliers; Grahovac, general manager, was named to the board of directors for the South Carolina Medical Equipment Services Association. van Halem and Grahovac have both been speakers at their association meetings. “I have worked with GAMES for many years, and I am...

ATLANTA - The van Halem Group has been given the “stamp of approval” by Ossur to provide clinical prescreen reviews and appeals services for custom orthotics and prosthetics for the manufacturer'scustomers.“It's a testament to Ossur and its allegiance to its customers to reach out to us on their behalf and seek out an arrangement like this to assist them,” said Wayne van Halem, president of the van Halem Group.The van Halem Group will provide, among other things, a prescreen...

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 - The van Halem Group will provide clinical prescreen reviews and appeal services for custom orthotics and prosthetics provided by Ossur's customers.The services will include, but will not be limited to, a prescreen review of documents to determine if all coverage requirements have been met prior to submission for reimbursement, as well as access to the van Halem Group's team of clinical experts.“We know all too well the challenges and hurdles our customers face when submitting claims...

ATLANTA - The SMRC is holding ordering practitioners accountable and acknowledging that provider payments for DMEPOS are reliant on their documentation, the van Halem Group reports.The requirement for practitioners to comply with a provider's request for documentation has been part of the Program Integrity Manual for some time, but in its most recent project detail for diabetic test strips, the SMRC says:“If a practitioner doesn't respond to a supplier's request for documentation to support...

ATLANTA - Providers must use Medicare Beneficiary Identifiers when billing Medicare beginning Jan. 1, 2020, the van Halem Group reminds them in a recent blog. The Medicare Access and CHIP Reauthorization Act of 2015 required CMS to remove Social Security Numbers from all Medicare cards by April 2019. CMS replaced SSN-based HCINs with new randomly generated MBIs. On Aug. 19, CMS reissued an MLN Matters article to show that all new Medicare cards have been mailed out and to encourage providers to use...

WASHINGTON - Providers who get request letters from the Office of Inspector General for documentation for CPAP replacement supplies need to take them seriously, because there could be a lot of money at stake, say industry stakeholders.Providers who receive such a request from the OIG are asked to either audit 100% of their claims for supplies going back six years, or pull a statistically valid random sample and extrapolate the results.“Providers have to pay attention because the potential downstream...

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.“The volume of audits and appeals has increased significantly and more folks are considering outsourcing that kind of work,” van Halem said. “We needed additional staff for the increase in our workload.”A big hire: Pam Felkins Colbert, an attorney who previously...