Medicare Archives

Making Sense of Shared Visits

David M. Glaser, Esq. May 26, 2021

CMS has deleted official guidance on the topic but promised that new guidance is still to come. It was pure coincidence that I was going

Sorting Out the Changes to the CMS Prior Authorization Program for Implanted Neurostimulators

Ronald Hirsch, MD, FACP, CHCQM, CHRI May 26, 2021

Hospitals must keep abreast of the changes and nuances as CMS adds new procedures for prior authorizations. We are approaching the second year of the

Kickbacks in the Medicare Advantage Program: $12.5 million Settlement in Whistleblower Case

Mary Inman, Esq. February 17, 2021

The first of its kind FCA case involves Roche and Medicare Advantage insurer Humana. The recent settlement of a whistleblower case involving the government’s Medicare

Philip Esformes Has Sentence Commuted

Timothy Powell, CPA December 24, 2020

I have written four previous articles on Philip Esformes, who was sentenced to 20 years in federal prison for a truly infamous scheme to defraud

Credible Allegations of Fraud Yield Immediate Medicare Payment Suspension

RACmonitor December 17, 2020

Credible allegations of fraud is a low standard to meet. If you are accused of Medicare fraud, your Medicare reimbursements will be immediately cut off

COVID Vaccines Begin Rollout as Medicare Announces Coverage

Mark Spivey December 15, 2020

Moderna’s vaccine is expected to be shipped to providers nationwide, on the heels of Pfizer’s. A reeling nation couldn’t have asked for a better Christmas

News Alert: Congress Keeps Government Open

RACmonitor September 30, 2020

Vote on the continuing resolution (CR) helps providers with Advanced Payments. The U.S. Senate passed a continuing resolution (CR) this evening, which will keep the

CMS Issues Early Release of MA Advance Notice

Mark Spivey September 17, 2020

The move contrasts with shorter timelines associated with the releases of the IPPS, OPPS rules. In an apparent effort to make providers’ lives a little

New Settlement Demonstrates New Fraud Type in Medicare Advantage program – Inflation of bids

Mary Inman, Esq. September 17, 2020

Two payers allegedly inflated their bids. Earlier this month, two Independence Blue Cross (IBC) subsidiaries in Pennsylvania agreed to pay $2.25 million to resolve allegations

The Audit Algorithm Arms Race in Medicare

Edward M. Roche, PhD, JD September 2, 2020

Providers forced to camouflage in mediocrity. EDITOR’S NOTE: This the first in a series of articles that explores the use of algorithms in the auditing of

CMS Issues Proposed Rule on Draft Policy Changes for Medicare Payments

Mark Spivey August 4, 2020

Telehealth and immunizations are two of numerous services targeted for revision. Federal officials are seeking public comments from providers on an expansive set of sweeping

Medicare