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»  Posts By   April 2014 

Frier Levitt Secures a Two-Million Dollar Medicare Appeal for Cardiology Group

Recently Frier Levitt pursued a Medicare appeal for a cardiology group that faced a 2.4-million dollar recoupment. Frier Levitt was able to have over 2-million dollars of the recoupment reversed at the redetermination stage (first level of appeal). This result is just one of the reasons why providers should seek guidance from qualified healthcare attorneys when faced with a Medicare audit. Here are a few other reasons: Medicare rules in...

Medicare Benefit Policy Manual Updated to Permit Payment for Physical Therapy, Nursing Care and Other Services

In January 2014, the Center for Medicare & Medicaid Services (CMS) updated its Medicare Benefit Policy Manual (“Policy Manual”) to reflect a change whereby Medicare will now compensate Medicare beneficiaries for certain skilled care, including physical therapy, nursing care, and other such services, without taking into account the patient’s likelihood of improvement or prognosis of a chronic disease. The clarification in policy will affect care provided by skilled care professionals...

CMS Proposed Revisions to Prescription Drug Benefit Program Met with Opposition

CMS has recently proposed revisions to the Medicare Advantage (MA) Program (Part C) and Prescription Drug Benefit Program (Part D) regulations that will significantly impact sponsors of prescription drug plans, pharmacy benefit managers, pharmacies, and other stakeholders. The proposed rule contains many technical and program changes. One proposed change would reduce the number of protected drug categories from six to three, eliminating the requirement for Part D plan sponsors to...

Client Alert: Health Care Fraud Prosecutions at Nationwide All-Time High

Criminal prosecutions under the federal health care fraud statute reached a record high of 377 new cases filed in 2013, according to Department of Justice data. This is an increase of 3% over 2012, and an increase of 9.9% over 2003. The data was analyzed by researchers at Syracuse University and presented in a recent report. The data also showed Southern Illinois as the top prosecution “hot spot” in 2013,...

More PBMs Moving to Compound-Specific Credentialing Processes In Effort to Demonstrate Protection Against Repetition of NECC

At the urging of Plan Sponsors, more and more Pharmacy Benefits Managers (PBMs) have begun designing and implementing compound-specific credentialing processes and compound-specific networks. This first major PBM to unroll this new model was Express Scripts, who in late 2013, early 2014 began requesting that certain compounding pharmacies complete a new, enhanced online recredentialing questionnaire, which asked many new and pointed questions regarding the pharmacy’s compounding and billing practices, as...