Author: Jessica McColgan
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16 January 2019 - 17:36, by , in Post Acute, Comments off
The Patient-Driven Groupings Model (PDGM), is the most significant change to the home health payment reform in the past 20 years. PDGM completely alters the methodology for calculating payments, and an example of this is the removal of therapy utilization as a component and the payment periods have been reduced from 60 to 30-days. In addition to the many clinical and overall operational modifications that will be required, these noteworthy changes in computing Medicare payment rates could also profoundly impact a provider’s PDGM reimbursement levels in comparison to historical PPS payment levels...
15 January 2019 - 13:54, by , in Blog, Post Acute, Comments off
A well thought out payer matrix can become the central knowledge base of any revenue cycle department. It’s a resource that will serve many operational purposes and ensure that organizational knowledge is well distributed without being lost.
cash flow maintenance
19 December 2018 - 10:52, by , in Blog, Post Acute, Comments off
Cash flow maintenance is paramount to sustaining any health care provider, especially through this era of rapid policy change and regulation. Organizations attempting to go through transitional phases such as process realignment and systems implementation are especially susceptible to reduced cash flow, both during and following these transitions...
18 December 2018 - 11:40, by , in Case Studies, by Market, Comments off
The home care provider was experiencing a high LUPA rates that consistently exceeded 15%. A staffing shortage, particularly with nurses, combined with communication challenges throughout made it difficult to achieve positive patient outcomes.
What Your Agency Needs to Know About Targeted Probe and Educate thumbnail blog-01
29 November 2018 - 13:35, by , in Blog, Compliance, Comments off
On October 1, 2017, Centers for Medicare & Medicaid Services began the Targeted Probe and Educate program to help providers reduce claim denials and appeals through one-on-one education. Each Medicare Administrative Contractor, studies the claim data submitted by each provider to determine providers who have high potential for claim error rates or unusual billing practices.
njhch
9 October 2018 - 14:20, by , in News, Comments off
Wayne, Pa. (October 9, 2018) – McBee Senior Clinical Consulting Manager, Dawn Cheek, RN, BSN, will present, “Are You Paying Attention to ADRs and Denials? Tips for Addressing ZPIC Issues,” during the 2018 Clinical Conference for Hospice & Home Care, hosted by the Home Care & Hospice Association of NJ (NJHCH). The conference will take place November...
wiahc fall conference
4 October 2018 - 13:00, by , in News, Comments off
Wayne, Pa. (October 12, 2018) – McBee Senior Consulting Manager, Michelle Stone-Smith, MBA, will present, “Managing Payer Source Change and Financial Benchmarking,” during the 2018 Fall Conference, hosted by the Wisconsin Association for Home Health Care (WiAHC). The conference will take place September 8-9 in Madison, WI. Ms. Stone-Smith is a health care leader with more than...
What Your Agency Needs to Know About Targeted Probe and Educate thumbnail blog-01
27 September 2018 - 9:44, by , in Blog, Compliance, Comments off
If a ZPIC shows up at your door, your agency needs to be ready. A large health system in Florida was a prime example of how an agency can struggle to be achieve compliance.
Interim Management
20 September 2018 - 11:35, by , in Case Studies, by Market, Comments off
The health system was unable to successfully fill several key leadership roles within their home care agency after a loss of leadership. Eleven critical positions were vacant within the clinical, quality assurance, and finance departments. As a result, leadership, strategy, quality performance, and compliance profoundly suffered...
Additional Reimbursement through Revenue Integrity
20 September 2018 - 11:23, by , in Case Studies, by Market, Comments off
Due to the constant flux in regulations, the hospital was not successful in capturing appropriate revenue for services rendered and was also not meeting compliance standards. To address these challenges, the need for a comprehensive review of their outpatient charges in relation to payer contracts was required...