Tag Archives: opga

House Subcommittee to hold hearing on Medicare fraud policies, RAC audits key topic

House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) announced yesterday that the Subcommittee on Health will hold a hearing on Medicare waste, fraud, and abuse, with a focus on the policies that address these problems.  Chairman Brady recently … Continue reading

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CMS begins rollout of fingerprint analysis for new DMEPOS providers

CMS recently released guidance on the rollout of their new fingerprint background check requirement for certain DMEPOS providers. It has been more than three years since CMS released their final rule on developing a fingerprint background check process for new DMEPOS and home health … Continue reading

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OTS Orthotics Defined… AGAIN!

When CMS released the 2014 HCPCS update codes late last year, they also provided guidance on how they would define “off the shelf” orthotics, for the purpose of identifying what type of provider could provide certain noncustomized devices to beneficiaries. After debate, CMS recalled … Continue reading

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Results of Jurisdiction D Lower Limb Prostheses Prepayment Probe

More results from prepayment reviews of lower limb prostheses in Jurisdiction D DMEMAC Medical Review Department below. Based on the continued high error rate (79%)  on claims asociated with L5987, Noridian will close this prepayment probe and open a wide … Continue reading

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CMS to Temporarily Halt RAC Audits to Transition to New Contracts

After receiving pressure from more than 111 individual members of congress about the over aggressive nature of CMS’ RAC audit program, CMS announced earlier this week that they will temporarily halt new RAC audit requests to allow existing contracts with … Continue reading

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ALJ Forum Light on Relief, Stakeholders Voice Frustrations

The Office of Medicare Hearings and Appeals held a forum today in Washington DC on the recently disclosed 460k Administrative Law Judge (ALJ) appealed claims backlog. Chief ALJ Nancy Griswold headlined a day long event which featured updates from OMHA … Continue reading

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OPGA to Attend Medicare Audits Hearings & Appeals Forum, Seeks Stories

The recent memorandum sent to Medicare appellant from Chief Administrative Law Judge Nancy Griswold detailing the incredible appeals backlog, and subsequent decision to suspend assigning dates for new ALJ hearings for the next 24 months, has created a fervor of … Continue reading

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Group Representing RAC’s Blasts ALJ Delays, Seeks Reform

Add the Medicare contractors lobby to the growing chorus of stakeholders calling for reforms to the current Medicare appeals process, specifically the recently announced delays to Administrative Law Judge (ALJ) level appeals. The American Coalition for Healthcare Claims Integrity (ACHCI), which represents Medicare contractors, … Continue reading

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Chief ALJ Details 460k Appeals Backlog, Suspension of Hearings

A recently obtained memorandum from the Office of Medicare Hearings and Appeals (OMHA) Chief Administrative Law Judge Nancy Griswold to Medicare providers awaiting multiple Administrative Law Judge appeal hearings details the exponential growth in appeals to Medicare audits. The letter provides the most … Continue reading

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Obamacare Update: State Health Exchanges, Medicaid See Enrollment Surge

As the calendar turns to 2014 and the Affordable Care Act (aka, Obamacare) continues moving its way through implementation, now is a good time to provide an update on the much-maligned state health exchange rollout and Medicaid expansion enrollment data to get … Continue reading

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