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. 

The proposed home health groupings model (HHGM) has resurfaced in an updated form—the Patient-Driven Groupings Model (PDGM).

You should check out your Home Health Agency’s (HHA) annual Program for Evaluating Payment Patterns Electronic Report (PEPPER). Why? This underutilized report uncovers risk areas in billing processes, provides insight into episode utilization, and compares your agency’s data to others in the market.

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.

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.

April of 2018 marks the beginning of Medicare’s transition to the new Medicare Beneficiary Identifier (MBI) which is slated to replace the current Health Insurance Claim Number (HICN) as the primary identifier for its beneficiaries.

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.

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...

CMS released a draft of the home health conditions of participation - CoPs - for review and comment to select industry groups. The CoPs have been regrouped into three sections--General Provisions, Patient Care, and Organizational Environment

On October 27, 2017, CMS released a draft of the home health conditions of participation - CoPs - for review and comment to select industry groups.