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Wednesday, February 14th, 2018
By: Denise M. Leard, Esq. In recent years, CMS has shifted its audit strategy. It has moved from a pay and chase model to a model in which it does not let the money out the door. In doing so, it has greatly increased the number of prepay audits it conducts. While a prepayment audit […]

Thursday, February 1st, 2018
Suppliers with insurance contracts need to understand how those contracts impact cash sale transactions. To help suppliers avoid legal landmines while navigating the DME cash-pay landscape, health law attorneys Jeffrey Baird and Lisa Smith presented a free webinar on August 2, 2017. Set out below are select questions and Brown & Fortunato’s answers, as well […]

Wednesday, January 17th, 2018
By: Jeffrey S. Baird, Esq. On January 31, 2017, CMS announced plans to consolidate all rounds and areas included in the Competitive Bidding Program (“Program”) into a single round of competition – Round 2019. After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competition conclude on December 31, 2018, Round 2019 contracts […]

Tuesday, January 16th, 2018
By: Jeffrey S. Baird, Esq. Assume that ABC Medical Equipment, Inc. (“ABC”) is 100% owned by John Smith. Assume that Smith also owns 50% of XYZ Medical Equipment, Inc. (“XYZ”) and 25% of DEF Medical Equipment, Inc. (“DEF”). Lastly, assume that, pursuant to a series of aggressive audits, ABC gets hit with recoupment demands that […]

Monday, September 11th, 2017
By: Jeffrey S. Baird, Esq. The current administrative appeals process is beyond unfair to DME suppliers. A supplier will get hit with a post-payment audit involving multiple patients. The auditing contractor will look for reasons to deny the claims and seek recoupment. The contractor will send a recoupment letter to the supplier … and then […]

Monday, September 11th, 2017
By: Jeffrey S. Baird, Esq. In a June 16, 2017 article in the Harvard Business Review entitled “Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes,” David J. Bailey, M.D. (President/CEO of Nemours Children’s Health System) stated: “Despite spending twice what other developed nations spend on a per capita basis for health care, […]

Monday, September 11th, 2017
By: Jeffrey S. Baird, Esq. Over the past four years, there has been a noticeable growth in the orthotics market. The reasons for this growth are: (i) orthotics are not covered by competitive bidding; (ii) Medicare has historically paid well for orthotics; and (iii) it is relatively easy for a DME supplier to ship orthotics […]