Compliance
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PDGM Compliance Risk Areas
28 March 2019 - 10:16, by , in Blog, Compliance, Comments off
When health care providers repeatedly fail to reach compliance with the Office of the Inspector General’s (OIG) guidelines, the OIG will issue them a Corporate Integrity Agreement (CIA). Under the CIA process, organizations enter into a mandatory agreement to improve their practices over a five-year time frame with outlined compliance guidelines set forth by the OIG.
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.
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.
PDGM Compliance Risk Areas
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.
Compliance
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.
Compliance
13 June 2018 - 10:35, by , in Blog, Compliance, Comments off
With the Centers for Medicare & Medicaid Services (CMS) release of the updated Conditions of Participation (CoPs) in the beginning of 2018, it is more important now than ever for agencies to assess their compliance plan.  The new CoPs introduced the Infection Control Program, QAPI Program, Emergency Preparedness, and modifications to current CoPs. Surveyors will look to see if agencies have successfully introduced these new changes into their plans, as well as policies and procedures – paying special attention to the standards that relate to the highest quality patient care.
Compliance
29 May 2018 - 11:32, by , in Blog, Compliance, Comments off
From from intake and registration to claim adjudication, there are several administrative and clinical functions that contribute to the timely capture and collection of patient service revenue. It is crucial for providers to identify compliance risk areas to realize revenue.
Audit
10 February 2018 - 9:14, by , in Blog, Compliance, Comments off
The Recovery Audit Contractor (RAC) Performant Recovery, Inc. announced last month that they will conduct a complex home health review for documentation and medical necessity. They will do an annual additional development request (ADR) limit that will be one-half percent (0.5%) of the total Medicare paid claims from the previous year.
ZPIC Audits
24 January 2018 - 13:40, by , in Blog, Compliance, Comments off
Should your agency receive a ZPIC Audit being prepared is a key step to ensure documentation and billing compliance. Taking a proactive approach is necessary. Learn from our clinical compliance expert, Dee Geray, about the best steps to take to prevent a ZPIC audit...
15 December 2017 - 10:18, by , in Blog, Compliance, Comments off
Check out these tips when coding blindness and low vision. Documentation training and education is crucial to correctly code blindness and low vision conditions. Category-level tabular instruction at H54.- (Blindness and low vision) requires...