Author: Jessica McColgan
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   Case Studies



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.
PDGM Clinical Coding Challenges
3 April 2019 - 14:46, by , in Blog, Post Acute, Comments off
In the 2020 Patient-Driven Groupings Model (PDGM) environment, LUPAs will become even more complicated with the introduction of the multifaceted structure of visit requirement variables. Like so many other aspects of PDGM, this change in calculation requires your attention.
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...
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.
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...