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Although capped, more plaintiffs are expected to be included in a second lawsuit. EDITOR’S NOTE: Virginia Gov. Ralph Northam, along with six managed care organizations (MCOs), have been named as defendants in a federal lawsuit filed on Sept. 25, claiming that more than a dozen of the state’s Medicaid behavioral…
AI presents an entirely new landscape for defense against audits. The Trump administration has launched a program to employ artificial intelligence (AI) in Medicare audits. Use of AI will make obsolete current legal strategies leveraged when defending providers. On Oct. 3, at a giant rally in Florida, the U.S. President…
Physicians are sure to bristle at a perceived push toward non-physician practitioners operating more independently. EDITOR’S NOTE: President Donald Trump last Thursday signed an executive order tweaking the Medicare system during a campaign-style rally at The Villages, a Florida retirement community. In reporting on last week’s executive order signed by…
Providers should keep in mind that such policies aren’t binding – but can offer valuable direction. Imagine your Medicare Administrative Contractor (MAC) had a policy detailing their coverage of records documented by a scribe.  Say that policy had been revoked. You have located a policy by another MAC, CGS. Would it be…
As a Medicare/Medicaid healthcare provider, you have a property right to your reimbursements for services rendered that were medically necessary. Why does it matter if your Medicare or Medicaid reimbursements constitute property rights? If you have a property right to something, it cannot be taken from you without due process…
The nonprofit news service alleges the federal government violated the Freedom of Information Act by refusing to disclose documents reflecting risk adjustment validation data. Kaiser Health News (KHN) has filed a federal lawsuit against the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human…
To understand the difference it is helpful to know the regulatory hierarchy. Last week’s article describing how Local Coverage Determinations (LCDs) are not binding prompted a question: what about National Coverage Determinations (NCDs)?  Are NCDs afforded more weight than LCDs? The answer is a resounding “yes.” NCDs are binding, but…
Noridian uses scenarios for the parenteral administration of iron in non-dialysis patients. The Noridian iron infusion Local Coverage Determination (LCD) is important for just about everyone since Noridian is the Supplemental Medical Review Contractor (SMRC). Noridian could end up reviewing and denying your claims even if you’re not in Noridian’s…