The presence of a CMS Quality Improvement Organization (QIO) representative at an Administrative Law Judge (ALJ) hearing are now the norm. These QIO Reps are armed with a formal Position Paper opposing claim coverage. THIS introduces a level of clinical, regulatory, and legal scrutiny that can materially shift the outcome of an appeal. These Position Papers are typically constructed with precise references to the Medicare Benefit Policy Manual, Conditions of Participation,

Evidence From FY 2023 CMS Data and Implications for Agency Governance, Compliance, and Financial Sustainability The Centers for Medicare & Medicaid Services (CMS) continues to expand prior authorization and pre-claim review programs as central mechanisms to reduce improper Medicare payments while preserving beneficiary access to medically necessary services. The Review Choice Demonstration (RCD) for Home Health Services represents a mature application of this strategy, shifti

Source and Credit: Home Health Care News, By Audrie Martin | May 28, 2025 The Centers for Medicare & Medicaid Services (CMS) announced...

If you are attending ACHCU Academy in Dallas, TX on March 3rd-5th, you will not have double vision. What you will have, is a double...

Source; Centers for Medicare & Medicaid Services (CMS) The CMS Hospice Special Focus Program (SFP) will monitor hospices identified as...

To learn more about Nancy's experiences and what she can help you with, please take a few minutes to watch the video. We couldn't be more...

HOME HEALTH and HOSPICE PROVIDERS Release Date: February 15, 2024 MLN Matters Number: MM11808 (link) Effective Date: July 1, 2024 Related...