In the 34th Edition of the User’s Guide for Short-Term Acute Care Program for Evaluating Payment Patterns Electronic Report (PEPPER)(ST PEPPER User’s Guide), the Centers for Medicare and Medicaid Services (CMS) has included a new target area – Severe Malnutrition. Also effective with the Q3FY21 release, CMS is discontinuing the Transient Ischemic Attack target area. …
Severe Malnutrition Added to Short-Term Acute Care PEPPER Read More »
Auditor Update: Part III Federal healthcare audits are back with a vengeance following a brief COVID-related pause. In August 2020, the Centers for Medicare & Medicaid Services (CMS) was required to resume Comprehensive Error Rate Testing (CERT) program activities that were temporarily suspended in response to the COVID-19 public health emergency (PHE). Based upon the …
Earlier this week, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the distribution of approximately $9 billion in Provider Relief Fund (PRF) Phase 4 payments, from a pool of $17 billion, to health care providers who have experienced revenue losses and expenses related to the …
One More Audit – $10,000 or More in Provider Relief Fund Payments Read More »
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 …
