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Tag: Wayne van Halem


Navigating lead generation safely

Specialty Providers

Navigating lead generation safely

December 29, 2020Theresa Flaherty, Managing Editor

ATLANTA - Wayne van Halem gets contacted “all the time” by companies that are having issues with audits. A common factor? Lead-generating companies, he says. These are companies that are new to the industry and those that are well established, he says. “They will convince people that they can make them a lot of money,” said van Halem, president of The van Halem Group. “They get told, ‘We’ll do all the work and the paperwork, and all you have to do is...

Lead generation, Orthotics, Round 2021, Wayne van Halem


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Gov't officials warn about coronavirus-related fraud

June 1, 2020Liz Beaulieu, Editor

ATLANTA - The government is already seeing fraudulent scams related to the coronavirus pandemic, says Wayne van Halem, including, unfortunately, a scam involving DMEPOS.van Halem, an Accredited Healthcare Fraud Investigator and Certified Fraud Examiner, recently participated in a webinar hosted by the National Healthcare Anti-fraud Association, during which special agents from the Office of Inspector General/Office of Investigations reported Medicare beneficiaries are being told in unsolicited phone...

Coronavirus Outbreak, Home Medical Equipment, Wayne van Halem


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Also Noted

FODAC names van Halem to board

March 25, 2020HME News Staff

TUCKER, Ga. - Friends of Disabled Adults and Children, a nonprofit organization providing more than $10 million annually in DME and supplies to those disabilities, has added Wayne van Halem to its board of directors. van Halem is president of the Atlanta-based The van Halem Group, a national consulting firm that counsels clients on applicable laws and regulations related to Medicare and other payers. “Wayne's extensive experience in regulatory issues and compliance, specifically related to...

Board of Directors, FODAC, Wayne van Halem


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Auditors avoid appeals process, make 'major' requests

November 27, 2019Liz Beaulieu, Editor

YARMOUTH, Maine - If you're an HME provider trying to appeal a denial by a managed care payer, it's probably not going very smoothly, reports consultant Wayne van Halem.“There's a process for appeals they have to follow that's outlined in the managed care manual and they're not doing that,” said van Halem, president of the van Halem Group.The process is similar to Medicare's: a number of levels of appeals, including redetermination, reconsideration and administrative law judge or ALJ.Instead...

Home Medical Equipment, Sylvia Toscano, Wayne van Halem


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Auditors avoid appeals process, make 'major' requests

September 13, 2019Liz Beaulieu, Editor

YARMOUTH, Maine - If you're an HME provider trying to appeal a denial by a managed care payer, it's probably not going very smoothly, reports consultant Wayne van Halem.“There's a process for appeals they have to follow that's outlined in the managed care manual and they're not doing that,” said van Halem, president of the van Halem Group.The process is similar to Medicare's: a number of levels of appeals, including redetermination, reconsideration and administrative law judge or ALJ.Instead...

Audits, Managed Care, Wayne van Halem


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HIPAA compliance: Providers have homework to do

November 20, 2018Liz Beaulieu, Editor

WASHINGTON - The finding that zero of the “covered entities” recently audited by the Office of Civil Rights fully complied with HIPAA requirements is a “wake-up call” for HME providers, says Wayne van Halem.What's more, the OCR found that more than 80% of “covered entities” made minimal, negligible or no efforts to comply with the requirements.“Our industry is really vulnerable here,” said van Halem, president of The van Halem Group, a division...

HIPAA, OCR, Wayne van Halem


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Editorial

Is TPE really as easy as 1,2,3?

September 24, 2018Guest Commentary

As you are likely well aware by now, Medicare has transitioned away from widespread prepayment review and is now full speed ahead on their Targeted Probe and Educate (TPE) audit program. The key word here being “targeted.” The widespread medical review audits were previously focused on procedure codes and not necessarily on providers. Anyone submitting claims for codes under review were subject to prepayment audits. Now, they pick specific suppliers to focus their audit efforts on based...

Targeted Probe and Educate, TPE, Wayne van Halem


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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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Settlement update: A non-option option for appeals

December 8, 2017Liz Beaulieu, Editor

WASHINGTON - CMS has rolled out a new settlement option for low-volume appeals, but it's not likely HME providers will take the agency up on its offer, stakeholders say.Providerswith fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council combined as of Nov. 3, 2017 with a total billed amount of $9,000 or less per appeal could be eligible, if certain other conditions are met.The kicker: CMS will settle eligible appeals at 62% of the net allowed...

ALJ Appeals, Andrea Stark, Ross Burris, settlement conference, Wayne van Halem


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HME: Not so hip on HIPAA?

October 13, 2017Liz Beaulieu, Editor

ATLANTA - Industry consultants report a number of HIPAA-related audits making the rounds in the HME industry and the best they can tell, providers, for the most part, are not prepared for them.The key elements of HIPAA compliance revolve around three safeguards, says Wayne van Halem: administrative (do you have policies and procedures in place, and do you perform training and education); physical (where are you storing your physical records, and are they secure?); and technical (where are you storing...

Audits, HIPAA, HIPAAwise, Wayne van Halem


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