A provider or supplier (or their representative) can utilize the Medicare Appeals Process (Section 1869 of the Social Security Act and 42 CFR part 405 subpart I contain the procedures for conducting appeals of claims in Original Medicare (Medicare Part A and Part B)). However, in order for an appeal to be available, you must …
Provider/Supplier Medicare Appeals Process & Practice Notes Read More »
The Centers for Medicare and Medicaid Services (CMS) requires documentation to support coverage and payment of services provided to Medicare beneficiaries. These requirements stem directly from Title XVIII of the Social Security Act (Act), Section 1833(e): No payment shall be made to any provider of services or other person under this part unless there has …
Steven A Greenspan JD LLM There are a couple of powerful auditors looking at fraud, waste, and abuse in the healthcare arena with whom you hope to never have the pleasure of interacting. One is the Health and Human Services (HHS) Office of Inspector General (OIG). It is the largest inspector general’s office in the …
Steven A Greenspan JD LLM CMS Adds Five (5) States Requiring Licensure & Enrollment with NSC The Centers for Medicare and Medicaid Services (CMS) issued Transmittal 11002, Change Request (CR) 12282 (r11002otn.pdf (cms.gov), on September 13, 2021, to communicate the addition of HCPCS codes that require the use of a licensed/certified orthotist or prosthetist for …
CMS Issues Additional Payment Edits for DMEPOS Suppliers Read More »
William OMalley Medicare expects providers to exercise care when billing and accepting payment. Medicare also expects that providers will promptly bring incorrect payments to the Medicare Administrative Contractor’s (MAC) attention. First Coast Service Options (FCSO), on December 17, 2021, issued a notification to Medicare providers explaining that, at times, providers receive incorrect payment, such as …
