Medicare Local Coverage Determinations Create Inconsistency in Medicare Coverage
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 Local Coverage Determinations Create Inconsistency in Medicare Coverage

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. That is…

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Medicare Part D Expert Witness
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…

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OIG Regulatory Guidance Standards
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)…

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Medicare Changes to Skilled Nursing PDPM in 2020
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…

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Pharmacy Benefit Manager Expert Witness
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.…

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U.S. District Judge Lew Affirms Michael F Arrigo as Expert Witness 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:…

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Expert witness ambulatory surgery center billing Morning Edition National Public Radio, Kaiser Health News Quote Expert Michael Arrigo RE High Cost Medical Care
Image credit: Kaiser Health News. Janet Winston stands in her rose garden in Eureka, Calif. Testing revealed she is allergic to numerous substances, including linalool. Winston still can handle roses, which contain linalool, but she can't wear perfumes and cosmetic products that contain the compound.

Expert witness ambulatory surgery center billing Morning Edition National Public Radio, Kaiser Health News Quote Expert Michael Arrigo RE High Cost Medical Care

Expert witness ambulatory surgery center billing Expert witness ambulatory surgery center billing quoted in allergy test overbilling investigation.  Michael Arrigo interviewed by journalists at National Public Radio (NPR) for broadcast…

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Medical Billing Expert Witness Howell and Collateral Source Rule

Medical billing expert witness Howell specials work in California in matters involving personal injury, medical malpractice, and payor provider disputes.  Experts should have  an understanding of the collateral source rule.…

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