Tag: Joshua Skora
Medtrade preview: Joshua Skora on implementing a payer playbook
March 15, 2024Tracy Orzel
DALLAS - When it comes to payer relations, success depends on the strength of your relationships, says speaker Joshua Skora.
Here’s what Skora, a health care regulatory attorney with K&L Gates who will be speaking on a panel at Medtrade titled “Building Relationships with Payers,” had to say about how both parties can benefit from successful relationships.
HME News: What are the priorities of commercial payers?
Joshua Skora: Commercial payers are concerned...
Overpayments: Create culture of compliance
August 22, 2016Josh Skora
A. In previous columns, I discussed how the 60-day overpayment rule presents a myriad of problems and questions that are sometimes difficult for an HME supplier to identify and address. However, the most effective remedy to overpayment problems is the implementation of and adherence to a robust compliance program. Overpayments will still arise, but the compliance program sets the stage for a corporate culture of compliance.
The Affordable Care Act mandates that suppliers have compliance programs,...
Overpayments: Follow protocol
July 25, 2016Josh Skora
A. Typically, suppliers report and return overpayments to the DME MAC of jurisdiction. Each DME MAC has a standard overpayment refund form. The supplier simply provides information and submits a refund check. Suppliers must indicate a reason for the overpayment. A few of the available reasons are: billed in error, insufficient documentation, services not rendered and medical necessity. The refund is a dollar-for-dollar payment. No penalty is assessed.
On the other hand, in cases that involve...
Overpayments: Extrapolate overpayments
June 21, 2016Josh Skora
A. My last column explained CMS's final rule clarifying the 60-day rule, which allows a supplier up to six months to quantify an overpayment once it's identified. Once the supplier quantifies the overpayment, it has 60 days to report and refund the overpayment. However, there is little, if any, guidance on how in-depth an investigation must be to quantify the scope of an overpayment.
Take the following hypothetical: A supplier has a sales representative in each of the five states it conducts...
Overpayments: Exercise reasonable diligence
May 23, 2016Josh Skora
A. The Affordable Care Act requires a person who has received an overpayment to report and return the overpayment to the government.
For HME providers, overpayments must be reported and returned within 60 days after the date on which the overpayment was identified. This led to many unanswered questions. What does “identified” mean? If a provider uncovers one overpaid claim, is it required to investigate all related claims? When does the 60-day clock start? How far back must the provider...