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July 27

“Grace Period” Coverage Under Exchange Plans: How Federal Regulations Can Alter Eligibility Determinations for Providers

By Matthew Horton, Washington & West, LLC The Affordable Care Act (ACA, or commonly referred to as Obamacare) altered the landscape for individual and small group insurance plans. ACA altered this market with two important provisions: (1) the creation of Qualified Health Plans (QHPs, also referred to as Exchange Plans) and (2) establishing Exchanges (also […] Read More

July 20

CMS Issues Unified Program Integrity Contract (UPIC) RFP

On July 17, 2015 the Centers for Medicare and Medicaid Services (CMS) published the RFP for services under the Unified Program Integrity Contract (UPIC). Responses to the RFP are due by August 18th at 12:00 pm (EST). Read More

July 1

CMS Issues Proposed Updates to the “Two-Midnight” Rule

On July 1, 2015, CMS released proposed updates to the “Two-Midnight” rule regarding when inpatient admissions are appropriate for payment under Medicare Part A.  The proposed updates were included in the calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.  As per the fact sheet, CMS is: Proposing to change the standard […] Read More

June 25

BREAKING: Supreme Court Upholds Subsidies

The Supreme Court ruling in King v. Burwell (11-114) upholds the Federal tax subsides of the Patient Protection and Affordable Care Act.  As per the Court’s ruling: “Petitioners’ plain-meaning arguments are strong, but the Act’s context and structure compel the conclusion that Section 36B allows tax credits for insurance purchased on any Exchange created under […] Read More

June 23

CMS Extends Recovery Audit Program Contracts

On June 22, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a Special Notice indicating that they intend to extend the active recovery auditing period for the existing four Medicare fee for service Recovery Audit Program contracts through July 31, 2016 in accordance with FAR 6.302-1.  The Special Notice indicates that it will […] Read More

June 22

We’re Off to Orlando!

We’re excited to be exhibiting at this year’s HFMA National Institute.  If you will be attending, we hope you will find us in the exhibit hall (booth #651).  The hall hours are: Monday, June 22 6:00 – 8:00 PM Tuesday, June 23 11:00 AM – 2:15 PM 3:30 – 5:30 PM Wednesday, June 24 10:45 […] Read More

June 9

CMS Presolicitation Notice: Unified Program Integrity Contract (UPIC)

On June 5, 2015 CMS issued a presoliciation notice indicating that they will be issuing a Request for Proposal (RFP) to solicit services for the Unified Program Integrity Contract (UPIC).  As per the notice, “the UPIC will combine and integrate existing CMS program integrity functions carried out by multiple contractors and contracts into a single […] Read More

Sarah Mendiola May 18

Sarah Mendiola to Present at Association for Clinical Documentation Improvement Specialists (ACDIS) Annual Conference

Sarah Mendiola, W&W’s Director of Clinical and Legal Services will present at the Association for Clinical Documentation Improvement Specialists (ACDIS) Annual Conference in San Antonio, Texas on Tuesday, May 19th.  Ms. Mendiola’s presentation, titled “Completing the Circle: The Importance of CDIS Participation in the Denial Management Process,” will present actual examples of costly denials that […] Read More

Sarah Mendiola April 14

Defending Against a ZPIC or other Potential Fraud Investigation by the OIG

W&W Director of Clinical Services and Senior Associate, Sarah Mendiola, will present at the Spring Meeting of the Iowa Chapter of the HFMA on April 16th.  Ms. Mendiola’s presentation, “Defending Against a ZPIC or other Potential Fraud Investigation by the OIG,” will explore the growth in auditing that is being performed by ZPICs and the […] Read More

Kelley Regan April 14

HFMA Hudson Valley Annual Institute

Attorney Kelley Regan-Costello and Professional Relations Representative, Megan Jones, will be exhibiting at the April 15th HFMA HudsonValley NY Annual Institute in Tarrytown, NY .  If you are planning on attending the Annual Institute, please stop by our booth and say hello. Read More

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