Home Health Patient Driven Groupings
Home Health Patient Driven Groupings The Centers for Medicare and Medicaid (CMS) announced a new Patient-Driven Groupings Model for Home Health that replaces the Prospective Payment System effective January 1,…
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Medicare Future Sounds Like Medicare Past
Forbes published an article on December 11, 2019, after interviewing the Administrator of the Centers for Medicare and Medicaid Services (CMS), Seema Verma. Ms. Verma itemized three focus areas: the lack…
Medicare administrative contractors (MACs) and the Centers for Medicare & Medicaid Services (CMS) sometimes develop policies to limit Medicare coverage of specific items and services. MACs issue local coverage determinations (LCDs) that limit coverage for a particular item or service in their jurisdictions only. This can lead to State-by-State variation in Medicare coverage for similar items and services.
Medicare LCDs Create Inconsistency in Medicare Coverage
Medicare LCDs Medicare Local Coverage Determinations (LCDs) are inconsistent and cause uneven access to care for Medicare beneficiaries based on arbitrarily geographic boundaries and jurisdictions, rather than on medical necessity.…
Medicare Part D and Medicare Part C Appeals Process is Essential Expert Witness Specialized Knowledge
Medicare Part D Expert Witness
A Medicare Part D Expert Witness should understand the differences between how Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part C are administered. Finding a Medicare…
How healthcare can benefit from blockchain
When considering how blockchain can help healthcare, it's first useful to consider what the barriers to adoption and barriers to entry are. The barriers to entry for new blockchain solutions…
OIG Regulatory Guidance from the Office of the Inspector General for U.S. Department of Health and Human Services
OIG Regulatory Guidance Standards
What is OIG Regulatory Guidance in Healthcare? OIG Regulatory Guidance has seven elements and is divided by the healthcare industry sector. The U.S. HHS Office of the Inspector General (OIG)…
Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
Medicare Changes to Skilled Nursing PDPM in 2020
As of 2020, CMS has mandated that Skilled Nursing Facilities (SNFs) adopt the new Patient-Driven Payment Model (PDPM), certification surveys. Additionally, SNFs must use the QAPI process. QAPI is the…
Medicare 2020 Skilled Nursing Facility PPS Final Rule
The Centers for Medicare & Medicaid Services (CMS) has issued the federal fiscal year (FFY) 2020 final rule for the skilled nursing facility prospective payment system (SNFPPS). Highlights of the…
Arkansas State ePrescribing Law Pases
Opioid Electronic Prescribing Law Passes in Arkansas
Opioid Electronic Prescribing Opioid electronic prescribing laws have changed in the past few years. For example, prescriptions for controlled substances such as opioids moved to a paperless, e-prescription system in…
Pharmacy Benefit Managers - U.S. Pharmacy Distribution and Reimbursement System
Pharmacy Benefit Manager Expert Witness
Pharmacy Benefit Manager Expert Witness A Pharmacy Benefit Managers expert witness (also known as PBM expert witness) must comprehend that Drug Prices are complex. First, I'm introducing some introductory concepts.…
U.S. District Judge Lew Affirms Michael F Arrigo as Expert in Medical Coding, Medical Billing, Medicare Fraud, Fraud Damages, Electronic Health Records
Expert witness Michael Arrigo was affirmed as an expert by U.S. District Judge Lew. To view the ruling click here: United States and State of California v Pacific Health Corporation. Excerpt:…