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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.
25 April 2019 - 13:37, by , in Blog, Post Acute, Comments off
Last October, Palmetto, one of the nation’s largest Medicare Administrative Contractors to the federal government, released their Electronic Comparative Billing Report (eCBR) for 2018 data between April 1 – September 30 that focused on hospice providers’ Non-Cancer Length of Stay (NCLOS) rates.
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 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.
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...
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.