Articles and Blogs

Effective July 1, 2025, Indiana Medicaid is no longer required to reimburse for services rendered during an Application for Emergency Detention (“AED”) without regard to medical necessity.   Background In 2023, Indiana overhauled its emergency detention framework through HEA 1006, which extended emergency detention to 14 business days, restructured procedures for initiating detentions and formally... READ MORE

On February 15, 2018, the Office of Inspector General (“OIG”) released a report announcing the results of a review it conducted of outpatient hyperbaric oxygen therapy (“HBO therapy”) claims. Of the 120 sampled outpatient claims under review, OIG found payment was made in accordance with Medicare requirements for only 18 claims. The audit, included... READ MORE

In response to the changes contained in the Patient Protection and Affordable Care Act (ACA) designed to address increasing lengths of stay in hospice programs, CMS added a “face-to-face encounter” requirement to the hospice certification requirements. Effective January 1, 2011, a hospice physician or nurse practitioner must have a “face-to-face” encounter with each hospice... READ MORE