I am involved in a fca claim against an acute care hospital involving medicare and medicaid issues-- 1) upcoding, 2) improper status changes for inpatient only procedures, and 3) violations of 3 day inpatient stay rules for transfer to snf facilities. The us attny reviewing the case has hired nurse practitioners to advise the us attny and i would like a medicare coding expert to weigh in and possibly serve as the chief plaintiff's expert in the case.+7 Other Responses
Medicare Advantage Plans
My firm is working on a project looking into the use of 3rd party prospective risk assessment providers for medicare advantage plans and we are looking to speak with experts responsible for decision making surrounding medicare advantage plans and any choosing any outsourced vendors used for prospective or retrospective risk assessment in relation to medicare advantage members and plans. Please only respond to this inquiry if you can answer the following questions:
• what is the current size of the market for risk scoring assessment services for medicare advantage members? Is there an optimal plan size for these types of services? How are these services are currently priced?
• are there any emerging business models or regulatory changes that would change the current way that these services are provided?
• how important do decision makers view these assessments? Who are the decision makers for vendor selection, what are the selection criteria, and what are retention dynamics in the marketplace? How likely are non-adopters to use prospective risk assessments in the future?
• what is the competitive landscape like for risk scoring assessment providers? What plans are using what vendors? Is it possible to differentiate on any dimension other than price?
Thank you.+18 Other Responses
Information is needed for new state of california medicare unit in the department of state hospitals. Need information in regards to claims, billing, processes, and coding. Our department is currently working on streamlining our billing for parts a, b and d. Looking for potential hire of a consultant.+8 Other Responses