Knicole Emanuel

Knicole Emanuel

Williams Mullen

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Medicare and Medicaid Appeal Deadlines and Procedures: Laws that EVERY Health Care Provider Should Know

If you are a physician, most likely, you are not a lawyer. And vice versa. While there are exceptions, generally, the professions of physicians and attorneys are mutually exclusive. Personally, one reason I went to law...more

2/24/2015 - Appeals Health Care Providers Medicaid Medicare Physician Medicare Reimbursements Physicians

Medicaid Reform in a House Divided and MCO, ACO…Who Cares?

We are living in the most polarized society in recent American history. A recent study shows that the feeling of political partisanship has more than doubled over the past 2 decades. So since 1995, politically, America has...more

2/11/2015 - ACOs Health Care Providers Healthcare Legislative Agendas MCOs Medicaid Medicaid Reform

Williams Mullen and Local Counsel, Bryan Davis, Win Declaratory Action Against HSD in New Mexico!!

For those of you who follow my blog, you know that the single state agency in New Mexico, Human Services Department (HSD), accused 15 behavioral health care providers, which made up 87% of the mental health care in NM, of...more

1/28/2015 - Declaratory Relief Fraud Health Care Providers Healthcare Healthcare Fraud Medicaid Mental Health

Low Medicaid Reimbursement Rates Violate the Supremacy Clause?! …The Supreme Court to Weigh In!

Today is a big day. Not only will most of us return to work after a long weekend, but the Supreme Court will hear oral arguments on a very important issue....more

1/20/2015

Medicare chief Tavenner stepping down; oversaw rocky health care rollout

News Alert: Medicare Chief Tavenner stepping down!!!! WASHINGTON — Medicare chief Marilyn Tavenner — who oversaw the rocky rollout of the president’s health care law — says she’s stepping down at the end of February....more

1/19/2015 - Administrative Appointments Affordable Care Act Healthcare Reform Medicare

Lordy, Lordy, Look Who’s Forty: A Review of Our 40-Year-Old Stalemate in Health Care Reform

Well, folks, it is official. I am “over the hill.” Yup. My birthday is today, January 7, 1975, and I was born 40 years ago. Instead of moping around, I have decided to embrace my 40s. For starters, let’s take a look...more

1/8/2015 - Affordable Care Act American Medical Association Health Insurance Healthcare Healthcare Reform Legislative Agendas Medicaid Medicaid Expansion Political Parties

AZ Supreme Court Holds AZ Legislators Have Standing to Challenge AZ Law, But Media Mischaracterizing the Lawsuit

It seems that the media have become so accustomed to polarizing the topic of Medicaid expansion that reporters seem incapable of truly assessing the issues objectively and reporting accordingly. This has happened recently...more

1/6/2015 - Healthcare Legislative Agendas Medicaid Medicaid Expansion Standing

A New Year and We Will “Ring In” Even Lower PCS Reimbursement Rates: Time for Litigation?

I received an email today from an owner of a home care agency that reminded me that, especially during the holidays, many people are struggling. This home care agency owner, “we will call him Al,” informed me that he...more

12/30/2014 - Healthcare Home Health Agencies Home Health Care Medicaid Reimbursements

OIG Report: MCOs Cause Limited Access to Primary Care for Medicaid Enrollees!

With flu season well under way, access to care to primary care physicians for Medicaid recipients is (as it is always) extremely important. During flu season, in particular, emergency rooms (ERs) are full of people suffering...more

12/15/2014 - Health Insurance Healthcare MCOs Medicaid OIG

Proposed Federal Legislation Will Provide Relief to Hospitals and Medicare Patients in Need of Post-Acute Care

The Center for Medicare and Medicaid (CMS) announced that the new RAC contracts in North Carolina should be ready by the end of the year. This means that, next year, RAC audits on hospitals and other providers will...more

11/26/2014 - CMS Healthcare Hospitals Medicare Proposed Legislation RAC Audits RACs SNF

Obama’s Executive Order, Its Impact on Health Care Costs, and the Constitutionality of Executive Orders

Pres. Barack Obama addressed the nation last night. He discussed his executive order that will delay deportations of up to 5 million migrants. What does an executive order on immigration have to do with Medicaid?...more

11/21/2014 - Affordable Care Act Barack Obama Deportation Executive Orders Health Insurance Immigration Reform Medicaid

Supreme Court Will Decide Whether Citizens in NC and 26 Other States Can Receive Tax Credits for Health Care Premiums!!

With a decision that, I can only imagine, ricocheted against the White House walls, the Supreme Court granted certiorari to hear King v. Burwell this past Friday, November 7, 2014, despite Obama’s administration’s request for...more

11/13/2014 - Affordable Care Act Certiorari Employer Mandates Halbig v Burwell Health Insurance Exchanges IRS King v Burwell SCOTUS Subsidies Tax Credits

New Mexico Senator Proposes Forefront State Legislation to Provide Due Process to Providers Accused of Fraud (Oh, And Here Are...

Whew…the election is over. No more political ads, emails, and other propaganda… Ok, so we have our new elected officials, now our new elected officials need to pass some new legislation protecting providers when it comes to...more

11/7/2014 - Allegations Due Process Election Results Fraud Healthcare Fraud Healthcare Providers Legislative Agendas

Source: [New Mexico] Human Services Secretary Squier Resigns!

“Gov. Susana Martinez’s controversial Human Services Department Secretary Sidonie Squier resigned on Thursday, sources inside the department confirmed,” according to the Santa Fe New Mexican....more

11/7/2014 - HHS Secretary of HHS

Black and Blue Medicaid Budgets, the ACA, and the Fear of the Unknown…

The unknown is what creates fear, right? For example, my husband is scared of heights. It is not the “heights” per se that scare him. He says that when he is high up, he gets an abnormal and understandably disturbing sense...more

2/4/2014 - Affordable Care Act CMS Healthcare Healthcare Reform Medicaid

Medicaid Card Warning: This Card Could Cause the State to Recoup From Your Estate!

Have you ever wondered about warning labels? I mean, some of them are so ridiculous that you have to wonder who the person was that created the need for such a ridiculous warning label. For example, the warning label...more

1/28/2014 - Estate Claims Medicaid

Possible Hospital RAC Audits in 2014: Pow! Right in the Kisser!

Whew…it’s a new year. While I thoroughly enjoyed 2013, I am excited and hopeful for 2014. Work is so busy that it seems like I’ve barely had time to breathe this January….that’s a good thing, right? Hey, anyone see me on...more

1/23/2014 - Audits Healthcare Hospitals Medicaid RACs

NCTracks Derailed: Class Action Lawsuit Filed!

My law partner Camden Webb and I filed a class action lawsuit today alleging on behalf of medical providers who accept Medicaid in North Carolina. ...more

1/16/2014 - Class Action Healthcare Medicaid

An Ominous Cloud Looms Over NC’s Mental Health System! And Radix Malorum Est Cupiditas!

Two phrases that can never be good when linked together: “an ominous cloud” and “mental health care system.” Upon reading “ominous cloud,” I get this dark (dare I say ominous?), dreary outlook on whatever the “ominous cloud”...more

1/15/2014 - Healthcare HHS Mental Health Parity Rule Mental Illness

NC Medicaid: With Diaz Gone, Who Will Provide the Cheery Soundbites About NC DHHS?

You know you know someone like this! No matter how horrible the circumstance, they just say positive things. You know, like a Disney character…oblvious to reality. Think about Snow White…her step-mother wants to kill her,...more

1/9/2014 - Medicaid

DHHS Blunder Could Cost Millions! “Oops I Did It Again!”

We can add one more “oops” to the Department of Health and Human Services (DHHS) repertoire of “oopses.” I am reminded of Captain Edward Smith when he banged the Titanic into an iceberg. Talk about an “oops” moment. Not to...more

1/8/2014 - Healthcare HHS HIPAA Medicaid Penalties

Hello, 2014! And Hello 3% Decrease in Medicaid Reimbursements (But Call the Decrease “Shared Savings”)

Tomorrow is the first Medicaid checkwrite for 2014. With the first Medicaid checkwrite tomorrow, due to Session Law 2013-360, many health care providers will receive 3% less in Medicaid reimbursements. You will receive a 3%...more

1/7/2014 - Healthcare Reform Medicaid Reimbursements

Medicaid Providers: Do Not Omit Information on Your Medicaid Application or NC Ct of Appeals Says, “You Can Lose Your Medicaid...

We’ve all told our share of little, white lies, right? “Yes, honey, you look fantastic in that dress!” Or… “I never think about my ex-boyfriend!” But omissions are also lies. People have told me in the past that omissions...more

1/3/2014 - Contract Formation Medicaid Omissions

CCME’s Prepayment Reviews Violate NCGS 108C-7!! Seriously!!

A few months ago I sent a public records request to the Division of Medical Assistance (DMA). I eventually received the information…today. I wanted to know how many providers had been put on prepayment review. ...more

12/27/2013 - Healthcare Professionals Medicaid Physician Medicare Reimbursements Physician Payments

CMS Declares the Payment Structure for the MCOs Violates A-87…”So What Happens Now?”

In North Carolina, we set up managed care organizations (MCOs) to manage behavioral health care for Medicaid. For the past year, I have been blogging that the MCOs’ payment arrangement with the Department of Health and Human...more

12/19/2013 - CMS Healthcare Healthcare Reform HHS Medicaid

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