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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. Since home health and hospice providers may have vast amounts of payers or locations, a payer matrix will be a vital tool for centrally storing information on obtaining insurance verifications, authorizations, billing guidelines, follow-up techniques, and reimbursement rates.
Restored Compliance
27 September 2018 - 9:44, by , in Blog, Compliance, Comments off
BACKGROUND: Compliant HHAs / OIG Intro When a Home Care Agency (HHA) is compliant, the agency is submitting claims in accordance with the current Centers for Medicare and Medicaid (CMS) regulations. The Medicare Integrity Program (MIP) was established to aid in CMS’s mission to detect and manage fraud. After the Medicare Modernization Act (MMA) took...
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. 
Utilization Review
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...
23 August 2018 - 8:13, by , in Blog, Post Acute, Comments off
OASIS Background As described by CMS, the Outcome and Assessment Information Set (OASIS) “is a group of standard data elements….designed to enable systematic comparative measurement of home health care patient outcomes at two points in time. OASIS-based quality measures can be used for quality improvement efforts that home health agencies (HHAs) can employ to assess...
25 September 2018 - 10:06, by , in Blog, Compliance, Comments off
More than any of the very complex modifications contained in the Patient-Driven Groupings Model, the most important enhancements emphasize the dire need for all agencies to have a solid and well-functioning episode management program in place before January 1, 2020.
27 July 2018 - 14:55, by , in Blog, Compliance, Comments off
The July release of the Home Health OASIS July 2018 Quarterly Q&As brings promise that CMS is back on track to continue quarterly updates that address agency OASIS questions. Perhaps, one of the most complex responses was the insight provided on “what is” and “what is not” a surgical wound in the context of PleurX catheters.
Magnifying Glass
25 July 2018 - 10:13, by , in Blog, Post Acute, Comments off
At the end of May 2018, CMS released a notice to providers describing their intention to implement an updated version of the previously paused Pre-Claim Review Demonstration. The revision is titled “Review Choice Demonstration for Home Health Services (RCD). Providers in the RCD states should not wait to act.
Magnifying Glass
12 July 2018 - 9:01, by , in Blog, Post Acute, Comments off
The proposed home health groupings model (HHGM) has resurfaced in an updated form—the Patient-Driven Groupings Model (PDGM).
Episode Management
29 June 2018 - 15:43, by , in Blog, Post Acute, Comments off
The new Conditions of Participation (CoPs) incorporate a focus on patient-centered care. A growing concept within the health care industry over the past several year, patient-centered is defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”  Effective episode management is critical to all home health agency’s success in incorporating patient-centered care strategies to increase compliance with these new conditions.