Two Success Stories: (1) Getting a Provider’s Suspension of Medicaid Reimbursements Lifted; and (2) NCSU Wins the ACC!
Medicaidlaw-nc
by kemanuel
1w ago
A quick shout out to NC State University, my undergraduate alma mater, who won the ACC Tournament, beating out #1 ranked UNC!!! I love legal success stories too. Because when my team wins, health care providers win. Well, my firm and I had a success that I must share amongst my blog readers. I gave this blog a live read on RACMonitor this morning on Monitor Monday, so if you want to hear me read it, go to wherever you listen to podcasts and search for RACMonitor. I present on RACMonitor every Monday morning and have done so for the last 10 years! One of my clients, a substance abuse facility ..read more
Visit website
Beyond Malpractice: Cultivating Trust and Safety in Health-Based Services
Medicaidlaw-nc
by kemanuel
1w ago
Today’s blog post is from a guest blog poster, Teresa Greenhill. Teresa Greenhill is the co-creator of MentalHealthforSeniors.com, which is dedicated to providing seniors with information on physical and mental fitness. Being a senior herself, Teresa, with some help from her granddaughter, manages the website as a way to keep her busy and help other seniors be active and happy in their golden years. So, without further ado, Beyond Malpractice: Cultivating Trust and Safety in Health-Based Services. By Teresa Greenhill Balancing providing individualized care and adhering to legal responsibiliti ..read more
Visit website
In Medicare Provider Audits, the Best Defense Is a Good Offense
Medicaidlaw-nc
by kemanuel
1M ago
Today I want to discuss upcoming 2024 audits. It has been almost four years since the world shut down due to COVID. Life has been divided into “before COVID” and “after COVID.” Before COVID, the Centers for Medicare and Medicaid Services (CMS) aggressively pursued audits against durable medical equipment suppliers, home health, hospice, behavioral health, long term care facilities and hospitals. When COVID hit, most audits were paused. But not for long. As you know, CMS resumed its audit activities as early as August 2020. However, in the world of COVID, there were exceptions to every rule, ma ..read more
Visit website
Medicare Can Force a Whistleblower to Dismiss When Smoking Gun is Smoke and Mirrors
Medicaidlaw-nc
by kemanuel
1M ago
2024 has already proven to be audit heavy. It seems that the repercussions of COVID are beginning to appear. Actions related to COVID, such as audits of dates of service (“DOS”) during COVID are commonplace now. Whistleblower actions also seem to be on the rise. We have even seen a few qui tam actions going forward even though the government did not intervene, which is rare, to say the least. In most cases, if the government does not intervene, usually, the whistleblower dismisses the case. The last qui tam action that I was worried was going to forward even though the government refused to in ..read more
Visit website
Knicole Emanuel Presents Webinar January 25, 2024!
Medicaidlaw-nc
by kemanuel
3M ago
A Guide to the RAT-STATS Statistical Software in Medicare and Medicaid Hosted by: Lorman Click here to register for the webinar on January 25, 2024, from 1:00pm-2:30pm! Join Nelson Mullins Raleigh partner Knicole Emanuel for a webinar hosted by Lorman on Jan. 25., 2024. Emanuel will be a speaker at the session entitled “A Guide to the RAT-STATS Statistical Software,” where attendees will learn about key considerations in interpreting sample size results for how to interpret and critically assess key factors influencing the extrapolation process, how to apply theoretical knowled ..read more
Visit website
CMS Issues Interim Rule in Response to State Medicaid Disenrollment Trend
Medicaidlaw-nc
by kemanuel
3M ago
When the COVID-19 Public Health Emergency (PHE) ended in April 2023, the Families First Coronavirus Response Act’s Medicaid continuous enrollment condition also came to an end. The condition had allowed States to claim a temporary monetary incentive for not disenrolling persons enrolled in Medicaid during the PHE, among other conditions. When this monetary incentive disappeared, many States moved quickly to disenroll recipients from the Medicaid program. In response to this trend, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule (Rule) on Dec. 6 ..read more
Visit website
Medicaid Expansion Set To Take Effect In North Carolina Today!
Medicaidlaw-nc
by kemanuel
4M ago
The AP (11/30, Schoenbaum) reports that “hundreds of thousands of adults in North Carolina” are set to receive Medicaid benefits, “a development that boosters say will aid hospitals and local economies in addition to the long-term uninsured.” As of Friday, “more than 600,000 North Carolinians are ultimately expected to qualify, with roughly half to be automatically enrolled.” The AP notes that “a 2022 report from the National Center for Health Statistics estimated North Carolina’s uninsured population at 17.6%, significantly above the national average of 12.6 ..read more
Visit website
Post-COVID Medicare and Medicaid Provider Audits Are Here!
Medicaidlaw-nc
by kemanuel
4M ago
My esteemed colleagues with curious minds, today we embark on a journey into the complex world of Medicare and Medicaid provider audits, specifically orchestrated by the enigmatic entities known as Recovery Audit Contractors, or RACs. The dates of service (DOS) during COVID are specifically being targeted, and I’ve seen an uptick. With the plethora of exceptions, you need a specialized attorney. Picture this: You’re a healthcare provider, diligently navigating the seas of Medicare and Medicaid reimbursement. All of a sudden, a tempest approaches – the Recovery Audit Contractors or RACs. These ..read more
Visit website
NC Medicaid Providers Lost Their Property Right in the Continued Participation in Medicaid, According to COA
Medicaidlaw-nc
by kemanuel
4M ago
According to the 4th Circuit Court of Appeals, health care providers possess a property right interest in the continued participation in Medicare and Medicaid. Nationally, the Circuits are split. The rule is, at least in the 4th Circuit, that termination for cause of a provider’s Medicaid contract is allowed, if the cause is correct and the provider was afforded due process. On October 5, 2023, the NC Court of Appeals deviated from legal precedent and ruled no property right exists in B&D Integrated Services v. NC DHHS and its agent Alliance. The COA held that Alliance, a managed care orga ..read more
Visit website
There Is No Law to Be Perfect in Medicare; Just Self-Disclose!
Medicaidlaw-nc
by kemanuel
4M ago
We all know that there is no law, regulation or statute that medical records supporting payment by Medicare or Medicaid must be perfect. There is no mandatory 100% compliant standard. Because humans err. In light of the ongoing financial strain brought about by the pandemic and the constraints imposed by Congress on Medicaid coverage disenrollments, State Medicaid agencies are poised to explore additional audits to manage increasing Medicaid expenditures. Recent developments, such as additional flexibilities granted by CMS, suggest a shifting landscape in how States respond to these challenges ..read more
Visit website

Follow Medicaidlaw-nc on FeedSpot

Continue with Google
Continue with Apple
OR