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11 March 2019 - 14:43, by , in Acute, Blog, Comments off
The health care industry has experienced significant change in the past decade. The pace of change is breathtaking! Organizations have grown and consolidated by acquiring hospitals, service lines and physician groups. Many organizations are now faced with the burden of standardizing their operations.
PDGM Clinical Coding Challenges
6 March 2019 - 11:58, by , in Blog, Post Acute, Comments off
The Patient-Driven Groupings Model (PDGM) is the most significant change to the home health payment reform in the past two decades.  The impact from PDGM is expected to significantly shift service delivery and will change the structure of home health reimbursements. A key component for calculating payment under PDGM...
14 February 2019 - 12:03, by , in Acute, Blog, Comments off
The Office of Inspector General (OIG) is reviewing payments under the Post Acute Transfer (PACT) policy again. Why? The OIG wants to ensure claims are properly paid by the MACs with the controls they have put into place through claim editing. The OIGs follow-up will determine whether
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...
15 January 2019 - 13:54, by , in Blog, Post Acute, Comments off
Although the January 1, 2019 implementation date has come and gone, agencies should not lessen their focus on accurate OASIS-D data set collection.  Just like any new process, agencies need to provide support through this OASIS-D learning curve. In addition to developing new assessment practices, clinicians are learning guidance that often conflict between items that assess the same functional activity.
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.