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CMS revised the requirements on “April 19, 2013 to delete “and indicating whether services were added to the HH plan of care by a physician who did not certify the plan of care” from the Provider Action Needed” section of MLN Matters numberMM8136 Revised...
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No matter which MAC or RAC reviews your agency, high risk probes are on the rise. The intermediaries are mandated by CMS to monitor areas of greater risk. The RACs are paid by contingency on aberrant findings. When either finds trends of concern they...
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No matter which MAC or RAC reviews your agency, high risk probes are on the rise. The intermediaries are mandated by CMS to monitor areas of greater risk. The RACs are paid by contingency on aberrant findings and their algorithms are making findings easier...
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This is THE topic one sees everywhere; trade journals, conferences, CMS, MLN, State Alerts, Home Health Associations. This topic is no longer just an operational and financial issue. Boards of Directors are looking to the Corporate Compliance Department...
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Tue, Jan 8 2013
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Filed under: hipaa, CMS, Home Health, Compliance, hospitals, ACO, Affordable Care Act, ACA, MLN, Affordable Care Act (ACA), HIPPA, Patient Centered Medical Homes, Hospital Readmission Reductions Program (HRRP), Corporate Compliance, (HRRP), Transitional Care Initiatives, Hospital Readmission Reductions Program
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Market Basket and Payment Rate Update On November 2, 2012, CMS released the Medicare Home Health Final Rule for the Home Health Prospective Payment System 2013. The proposal includes the 2013 Market Basket Index (MBI) update of 2.3%, the required 1 point...
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Tue, Nov 27 2012
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Filed under: Medicare, CMS, Home Health, Select Data, Compliance, Face to Face Encounters, ACA, Affordable Care Act (ACA), Therapy, NAHC, ICD-9CM Coding, M1024, Market Basket Index, LUPA Rates
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A nationwide class-action lawsuit brought by Medicare beneficiaries would eliminate the present CMS policy requiring Medicare beneficiaries to show a likelihood of medical and/or functional improvement before Medicare will pay for skilled nursing, physical...
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ICD-10 CM is going to impact the entire home health industry and every department of your agency. Now that we know that the implementation date will be October 1, 2014, agencies need to establish a solid plan now. You need every day of the 24 months to...
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Though, the Gap Analysis and ICD-10 Transitional Coding Plan was scheduled for this week. Please expect it next week. We believe, you will want to be aware of the OIG address to Congress earlier this month. On August 2, 2012, The Office of the Inspector...
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As a percentage of GDP, health care expenditures are about 18%. By 2019, the national health care expenditures will be 19.3% and approaching an unsustainable level. CMS states: Innovative approaches to quality healthcare must be found. New Models...
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Care Plan Oversight is physician supervision of patients under either the home health or hospice CMS benefit. CMS does not provide this reimbursement for these services if a patient resides in a nursing facility or skilled nursing facility. Physicians...
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Tue, May 15 2012
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Filed under: Medicare, CMS, Home Health, OASIS, Select Data, OASIS-C, Compliance, Coding, Physician Orders, Home Health Software, Plan of Care, G Codes, Home Care Compliance, Point of Care
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Do not be surprised if a CMS representative visits your agency after you apply for revalidation. Leaders are identifying that the visitors are taking pictures of the agency building and signage; taking pictures of the state license; as well as requesting...
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Mon, Apr 30 2012
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Filed under: CMS, Home Care, Select Data, Compliance, Coding, Affordable Care Act (ACA), Z-PICs, MICs, RACs, MACs, Home Health Software
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Predictive Analytics or Provider Profiling? Call it what you want, is your agency being monitored by CMS and/or state Medicaid etal? And, have you directly triggered an alert? Or, are physicians that sign orders for your agency patients being investigated...
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Thu, Apr 26 2012
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Filed under: Medicare, CMS, Home Care, Select Data, Compliance, Coding, Z-PICs, MICs, RACs, MACs, Home Health Software, SURS
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Despite the fact that it is a patient’s right to have appropriate pain management, evidenced-based pain management is not always followed consistently and thus pain management has attracted audit focus. Because pain is considered the fifth vital sign...
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CMS has, for years, suggested to healthcare providers across the care continuum that they must refine old and create new methods of providing care. Providers are expected to collaborate and coordinate to minimize the fragmentation in healthcare. They...
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Wed, Feb 29 2012
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Filed under: Medicare, CMS, Home Health, Home Care, Select Data, OASIS-C, Compliance, ACO, Coding, Z-PICs, MICs, RACs, MACs, Home Health Software
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RACs have recovered over 96% of all audited claims resulting in take-backs of over 2 billion dollars. Is it any wonder that the home health industry is concerned about their new focus in our industry? The RACs have been identified. The MACs, who will...
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Tue, Jan 31 2012
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Filed under: Survey, Medicare, CMS, Home Health, ICD9-CM Coding, Compliance, Home Health Care, Surveys, OIG, ICD-10-CM Coding, RACs, MACs, Home Health Software