Author Archives: Marc M. Meyer

Beaumont EMS Chief Moving to Pearland

Per the Beaumont Enterprise, Beaumont EMS Chief Max Nguyen has been hired by Pearland EMS.  There has been some questioning the operations of Beaumont EMS recently, but the administration of the City of Beaumont has been complimentary of Nguyen's tenure. After the jump is the story from the Houston Chronicle: Beaumont's ...

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City of Dallas Pays Nearly $2.5 Million to Settle Medicare/Medicaid Fraud Claim

Following the jump is a press release from the United States Department of Health and Human Services and Department of Justice regarding claims of upcoding by the Dallas Fire Department for Medicare and Medicaid claims.  I highlight this to note that it is not only the non-emergency ambulance services transporting dialysis patients that are paying ...

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Trailblazer Posts Notice Regarding Ambulance Dialysis Transport

Today, Trailblazer issued a notice the the ambulance supplier community regarding transports to and from dialysis.  Basically, Trailblazer is stating that based on alleged over utilization of ambulance transportation services for a residence to dialysis center transport (RJ and JR modifiers), they will pay the first 12 claims of the year without documentation.  After that, ...

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Yet Another Study Confirms That Calling EMS Improves Outcomes in Critical Cases

In yet another "Duh" type of statement, University of North Carolina researchers found that patients who call 911 with stroke symptoms get the necessary CAT scan of the brain 24 minutes faster than those who walk in to the ER.  Thus often translates into important differences in outcomes.  But if the media attention ...

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Medicare Audits Biting Houston Area Ambulance Companies Where It Hurts – In the Bottom Line

I have previously posted about the travails of one Houston ambulance service owner who had taken his complaints about the treatment of dialysis patients to the media.  Apparently, the initial reports were only the beginning - I don't watch the local Fox station, so I missed the follow up of the ...

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Medicaid Changes Don’t Bode Well for Healthcare System

The New York Times has been reporting extensively on the crisis in Medicaid.  On Wednesday, Robert Pear reported on the growing storm.  Money quote: To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring ...

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New Language Coming For Trailblazer Redetermination, Reopening Letters

Trailblazer has announced that they are changing some of the language regarding appeal rights if the provider is not satisfied with the results of the determination.  This is not a substantive change, but may change the look of these letters so it make sense to pay attention to the letters, at least for the next ...

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Trailblazer Will Start Auditing More Dialysis Transports July 1!

I received the following email from Trailblazer yesterday.  Expect ALL dialysis transports to be denied initially and require submission of additional documentation and eventually require at least appeals through redetermination.  This will be just like the current situation with the RJ/JR modifier (the home to dialysis and dialysis to home trips), except that now the ...

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New Compliance and Regulatory Blog

OMG, My friend, David Douglass is blogging!  David is the current vice-chair of the American Bar Association Health Law Section and a partner and practice group chair for Government Enforcement/Compliance for Shook, Hardy & Bacon in Washington DC.  And he has done alot of other cool things I am still finding out about ...

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Predictive Modeling Software and Healthcare Reimbursement: Coming Soon to a Medicare Contractor Near You

Jim Landers, a columnist with the Dallas Morning News who writes extensively on Medicare, recently wrote about this in a column (link here, but it is behind their paywall). Though this is really not a surprise to anyone following Medicare, PPACA (Obamacare) and the Medicare ZPIC and RAC contractors, CMS is rolling out Predictive ...

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