News & Analysis as of

Denial of Benefits Medicare

Weintraub Tobin

California Medi-Cal Enrollment Appeals: An Uphill Battle but an Essential Tool

Weintraub Tobin on

In our practices, we are seeing an increasing number of denials or de facto denials of Medi-Cal provider enrollments. The consequences of a Medi-Cal enrollment denial can be quite serious. First, a provider may not receive...more

Polsinelli

CMS Outlines New Standard for Challenging Medicare Payment Denials, Echoing Brand Memo on Force of Sub-Regulatory Guidance

Polsinelli on

On October 31, 2019, the Office of General Counsel for the U.S. Department of Health and Human Services (HHS) issued an important memo from Kelly M. Cleary, CMS Chief Legal Officer, and Brenna E. Jenny, Deputy General...more

Manatt, Phelps & Phillips, LLP

Health Update - July 2016

The Vulnerability of Healthcare Information - According to a report the Brookings Institute issued in May 2016, 23% of all data breaches occur in the healthcare industry. Nearly 90% of healthcare organizations had some...more

King & Spalding

CMS Issues Refunds For Collections Made On Incorrectly Identified Incarcerated Beneficiary Overpayments

King & Spalding on

Medicare does not cover supplies or services for persons who are incarcerated at the time the services are rendered. However, Medicare had purportedly paid providers in error for many such claims and sought to recover those...more

McDermott Will & Emery

CMS to Postpone Denying Claims When Ordering/Referring Provider Not Enrolled in Medicare

McDermott Will & Emery on

The Centers for Medicare & Medicaid Services will implement edits on providers ordering/referring Part B, durable medical equipment and Part A home health agency claims effective January 6, 2014....more

King & Spalding

CMS Releases Temporary Instructions for Implementation of Final Rule 1599-F for Part A to B Billing of Denied Hospital Inpatient...

King & Spalding on

On September 16, CMS released a Medicare Learning Network (MLN) article (SE 1333) detailing temporary instructions for the implementation of final rule 1599-FI relating to billing for Part B services that were provided during...more

Baker Donelson

CMS Reinstates Policy for Enrollment Denials Related to Unpaid Medicare Overpayments

Baker Donelson on

The saga related to CMS’ policy to deny enrollments based on a history of unpaid Medicare debts continues. We first reported on the proposed regulations and corresponding policy announcement, via Transmittal 469, expanding...more

Baker Donelson

CMS Temporarily Rescinds Implementation of Enrollment Denials Related to Unpaid Medicare Overpayments

Baker Donelson on

In the June 12, 2013 Payment Matters article “Enrollment Rules Continue To Provide Expanded Bases For Enforcement,” reference was made to CMS’ publication of Transmittal 469 to the Medicare Program Integrity Manual....more

BakerHostetler

CMS Addresses Hospital Rebilling After Inpatient Denials Through Interim Administrator Ruling and Proposed Rule

BakerHostetler on

On March 18, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register two important documents addressing the hotly contested issue of a hospital's ability to obtain payment under Part B for...more

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