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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...
Revenue Cycle Internal Audit
11 December 2018 - 15:50, by , in Acute, Blog, Comments off
Implementing a comprehensive internal audit program will position a facility to actively respond to the ever-changing healthcare regulatory environment. Achieving effective and compliant healthcare functions cannot occur without well-defined and ongoing compliance auditing.
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.
Process Wheel
26 October 2018 - 14:12, 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.
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.
Sequelae
17 September 2018 - 13:46, by , in Blog, Post Acute, Comments off
A common question asked among coders is, “is this a complication or is this a sequela”?  Following specific coding guidelines will ensure that costly errors are avoided for these two very different coding situations. 
UR Recovers 1.8M in Revenue
29 August 2018 - 12:57, by , in Acute, Blog, Comments off
The Utilization Review (UR) function in the emergency department (ED) serves as a critical component to ensure whether a patient is placed as inpatient or observation. Establishing the UR team to manage patient status at the point of admission is imperative to minimizing denials down the line. Too often, hospitals waste time and money by...
Comprehensive Internal Audit
23 August 2018 - 8:13, by , in Blog, Post Acute, Comments off
OASIS-D is the latest data set for home health agencies to utilize and will be effective January 1, 2019. The focus of this latest revision is on quality and comparison of those quality indicators.