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Provider Directory Accuracy – Health Plans’ Continuing Challenge

May 16, 2023

In 2018, CMS released a report that set forth the results of their review of Medicare Advantage online provider directories. The review examined the accuracy of 108 providers and their listed locations selected from the ...

The High Cost of Inaccurate Provider Enrollment for Nursing Homes

April 25, 2023

As providers of Medicare services, nursing homes rely heavily on the timely and accurate reimbursement from the government to ensure the provision of top-quality care to their residents. The negative financial implicatio...

Medicare expands mental health access to MHC and MFT practitioners

March 28, 2023

A recent and exciting CMS Medicare update for both benefit recipients and healthcare practitioners is that legislation that included expansion to mental health access was signed into law on December 29th, 2022. After sev...

Considering Medicare Advantage as Your Next Product Line? Things to Know…

April 5, 2022

Health plans considering Medicare Advantage or Medicaid as a new line of business need to be well informed of the greatly enhanced oversight and requirements they will face compared to state regulation of commercial plan...

2021 Audit Alert: Background Checks for Nursing Home Employees

February 22, 2021

In January of 2021 Centers for Medicare and Medicaid Services (CMS) announced that they would be auditing compliance with the National Background Check Program for Long-Term Care Providers. The National Background Check ...

CMS Preclusion vs OIG Exclusion

February 8, 2021

On January 1, 2019, the Centers for Medicare & Medicaid Services (CMS) introduced a new tool for Medicare plans – the CMS Preclusion List.  A previous article posted in 2018 provides an excellent overview of t...

COVID-19 Health Care Changes that May Survive the Pandemic

January 4, 2021

The COVID-19 pandemic has changed the face of the health care industry on multiple fronts. These range from the multiple blanket 1135 temporary waivers issued by CMS that control how care for federal program beneficiarie...

Survey and Accreditation Activities in the Age of COVID-19

December 21, 2020

As the first vaccines are delivered across the US, we can begin to look forward to a post-pandemic future and resuming routine activities that have been sharply curtailed in 2020.  This includes the resumption of the fu...

Pandemic-Related Waivers by CMS and the Continued Importance of monitoring OIG Exclusion Lists

December 14, 2020

COVID 19 has resulted in a flurry of waivers by federal and state regulatory agencies related to the provision of health care for Medicare and Medicaid patients. The CMS blanket waivers (issued as “1135 waivers” unde...

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Understanding OIG Exclusions

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