Scrutiny Of Medicare Advantage Plans
President Lyndon B. Johnson signed the Medicare Act into law in 1965. This set up the Medicare system…
April 5 2024Latest in: Billing/Reimbursement
Subcontract Arrangements: Key Issues
Third-party payor (TPP) contracts include Medicare Advantage (MA) contracts, Medicaid Managed Care (MMC) contracts, and employer-sponsored group health…
March 30 2024PDAC Verification Process: The Initial Application
The PDAC, which is a Medicare contractor, handles code verification.
March 22 2024CMS Addresses Change Healthcare Disruption
The Agency will consider applications for advance payments for Part B suppliers impacted by the Change Healthcare/Optum Payment Disruption.
March 15 2024Requesting An Office Of Inspector General Advisory Opinion
In the non-health care space, contracts, business arrangements, and joint ventures need to make sense from a financial…
February 23 2024Fraud In The Catheter Space
The New York Times recently published an article that discusses fraud in the catheter space...What are the lessons?
February 19 2024Using Offshore Subcontractors
The term “subcontract” is a fairly simple term. A subcontract arises when one company (“ABC, Inc.”) pays another…
February 9 2024Qualified Vs Unqualified Leads
What is perfectly legal in the non-health care space (auto parts stores, clothing stores, ice cream shops) can…
February 5 2024New CMS Rule Streamlines Communication And Prior Authorizations
As of Jan. 17, 2024, CMS has affirmed its commitment to advancing interoperability and improving prior authorization.
January 29 2024OIG Approves Gift Cards To Physicians, But Beware
DME suppliers are aware that they have to be very careful when it comes to providing gifts to…
January 12 2024