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February 12

HFMA Region 5 Dixie Insitute: Will We See You in Charleston?

Washington & West Co-Founder and Principal, Linda Fotheringill and Director of Professional Relations, Jude Crowell, will be exhibiting at the HFMA Region 5 Dixie Institute on February 17-20th in Charleston, South Carolina.  If you will be attending the Dixie Institute, please stop by our booth (Booth #8) and say hello.  We hope to see you […] Read More

February 3

Zone (Program Integrity Contractor) Defense: Successfully Navigating ZPIC Audits

Sarah Mendiola, Esq., Linda Fotheringill, Esq., Washington & West, LLC While the provider community has been focusing on combating denials from the RACs and MACs, audits by the Zone Program Integrity Contractors (ZPICs) have been quietly recovering hundreds of millions of dollars in identified overpayments. If you talk to a provider who has been involved […] Read More

November 10

The National RAC (and MAC) Summit

Attorneys Linda Fotheringill & Sarah Mendiola will be exhibiting at The National RAC (and MAC) Summit on November 13th-14th in Washington, D.C. If you will be attending the summit, please stop by our booth and say hello. Read More

October 29

CMS Revises Audit Timeframes For Complex Reviews

With publication of Transmittal 547 on October 17, 2014, CMS changed the audit time frame for complex reviews from 60 to 30 days for some MAC and Recovery Audit Contractor (RAC) reviews. Effective February 24, 2015, determinations in MAC complex prepayment reviews and RAC complex post-payment reviews must be issued within 30 calendar days of […] Read More

October 16

CMS Offers Hospitals List of Potentially Eligible Claims

On Wednesday, October 15th CMS updated the Medicare Appeals Settlement information with the following note: Note: Effective 10/15/2014, if a hospital is unable to produce a list of all eligible claims in a timely manner, the hospital may submit a request for a “Potentials List.”  CMS will respond within 2 business days with a list […] Read More

September 18

Is Chairman Brady’s Call for CMS to Retract the Settlement Process Likely to Derail the Settlement?

On the Friday before Labor Day, CMS offered a proposal to settle all hospital claims denied for lack of necessity for inpatient admissions (and still in the appeal process). For eligible claims the proposal offers to pay hospitals 68 % of the net allowable amount. Read More

September 8

CMS Automated Denial Policy Puts Doctors, Hospitals in the Same Documentation Boat

When a government agency decides not to adopt a policy “at this time,” it is a safe bet that policy is coming soon. Case in point: The Centers for Medicare & Medicaid Services has, for the second time this year, announced that it will allow its claim review contractors to deny any claim “related” to a claim that has been denied after documentation review. Read More

September 5

CMS Still Off the RAC: Litigation Forces More Delays in Awarding New Recovery Auditor Contracts

Medicare’s contracts with its most infamous post-payment review arm – the Recovery Audit Contractors – expired earlier this year, and CMS intended to award new contracts promptly to keep the work flowing. Read More

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