In CMS
Feb 13th, 2017
The deadline for Eligible Professionals (EPs) to submit Reconsideration forms for the 2017 payment adjustment—based on the 2015 EHR reporting period—is February 28, 2017. No applications will be accepted after the deadline. Visit the CMS website to find the EP Reconsideration Application. Complete this application if you received a letter from CMS saying you are subject to the 2017 Medicare EHR ...
In Audit
Oct 10th, 2012
By Douglas J. Jorgensen, DO, CPC, FACOFP If you disagree with a Medicare payer’s audit findings, you may appeal (see Exclusions on Medicare and Limitations on Payment, 42 C. F. R. Part 405, Subpart I). This is important because if Medicare successfully prosecutes you for fraud, you may face civil monetary penalties of $10,000-$15,000 per ...
In Audit
Dec 15th, 2011
The Centers for Medicare & Medicaid Services (CMS) recently clarified documentation rules for home health care provided following an acute or post-acute stay after CMS contractors denied payment in the following situations: The home health care agency (HHA) uses a single form (i.e., 485) for the plan of care and the certification with a single signature ...
Feb 25th, 2011
In response to physician feedback received by UnitedHealthcare (UHC) after the January release of the UnitedHealth Premium Program, the insurer is allowing certain physicians more time to submit their requests for reconsideration prior to online designation display. The extension, the insurer says, will give those physicians with a current designation display date prior to March 30 the time they n...
Oct 5th, 2009
Wondering what you should do if you receive a claim denial due to untimely filing that you believe to be unjust? Request a reconsideration. UnitedHealthcare offers advice on what you should submit as evidence of timely filing. For electronic claims, include confirmation that UnitedHealthcare or an affiliate received and accepted your claim. Effective Dec. 1, proof of ...