Using the New Request for Hearing Form for Medicare Appeals

The advent of revised regulations for administrative law judge (ALJ) hearings of Medicare appeals includes a new request for ALJ hearing or review of dismissal form. Because the new form — governed by 42 C.F.R. § 405.1014 — provides a logical flow of information for you and the public servants handling your appeal, you should[…]


Register Now: CMS Stakeholder Input Call for DMEPOS Non-CBA

CMS announced a call to discuss the non-CB impact of CURES with stakeholders on Thursday, 3/23 at 2p Eastern.  According to the CMN announcement, CURES mandates Stakeholder input on the methodology for using information from the DMEPOS Competitve bidding program for adjusting Medicare fee schedule amounts paid in non-CB areas. Learn about new legislation and provide[…]


DME Billing Alert: BCBS of NC Implementing Major Changes to Sleep Therapy Policies

Blue Cross and Blue Shield of North Carolina (BCBSNC) will implement a new Sleep Management Program effective June 1, 2017. The new program will consider the medical necessity of studies and the clinical appropriateness of a facility- or home-based test. Prior authorization will also be required for coverage of any subsequent treatment (therapy), both initial[…]


OMHA Announces ALJ Appeal Status Website

This week, the Office of Medicare Hearings and Appeals (OMHA) announced the launch of a new website which will allow providers to check the status of their ALJ appeals. The website, entitled the ALJ Appeal Status Information System (AASIS), intends to provide public access to appeal status information. The website is accessed through the OMHA[…]


BCBS pricing tool could shake up medical industry

Cary, North Carolina radiologist Stephen Loehr likes to think he runs a lean operation at his 14-employee outpatient practice, Triangle Vascular Associates. But pricing his services against other doctors and medical facilities has mostly come down to guesswork. Until now. A new online database from Blue Cross and Blue Shield allows Loehr to demonstrate to[…]


Healthcare giants make value-based payment pledge

With and without government, some of healthcare’s largest businesses, and those who pay for it, are mapping their own path to a critical mass of value-based payments. Aetna, Blue Cross giant Health Care Services Corporation, Ascension Health and Trinity Health are teaming up with employer and patient representatives to affect change through a new industry[…]


CMS must provide better oversight to prevent duplicate audits says GAO study

A newly released study by the federal General Accounting Office (GAO) found that the Centers for Medicare and Medicaid Services (CMS) needs to provide better oversight and guidance for provider payment auditors to prevent duplicative post-payment claims review audits. Several types of Medicare contractors conduct postpayment claims reviews to help reduce improper payments: Medicare Administrative[…]