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CMS is stating they expect 10% of all claims submitted to be denied with ICD-10 initially. Selecting and assigning accurate diagnoses in the proper sequence must be performed in compliance with Medicare rules and regulations, Coding Conventions and Coding...
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Thu, Apr 25 2013
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Filed under: ICD9-CM Coding, ICD-9, ICD-10-CM Coding, ICD-10-CM, Z-PICs, MICs, RACs, MACs, ICD-9CM Coding, ICD-9-CM
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The government is escalating investigations in 2013 through Recovery Audit Contractors (RACs), Medicare Recovery Contractors (MACs), Medicaid Integrity Contractors (MICs), Zone Program Integrity Contractors (Z-PICs), and now, the Health Care Fraud Prevention...
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Wed, Mar 6 2013
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Filed under: Home Health, Select Data, OIG, GAO, Coding, HEAT, Z-PICs, MICs, RACs, MACs, Corporate Compliance, RAC Demonstration Project, Code of Ethics, General Accounting Office, Corporate Compliance Plan, Office of Inspector General, Medicare PPS
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Issue One: Looking at Statistical Data Every time an OASIS is submitted to the state, portions of it may be parsed out to state, regional, and Federal groups such as the HEAT, MAC review groups, and Federal special projects in the DOJ and FBI. That means...
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Thu, Sep 13 2012
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Filed under: CMS, OASIS, OASIS-C, ICD9-CM Coding, Surveys, Patient Survey, ICD-9, HEAT, Z-PICs, MACs, ICD-9CM Coding
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Developing a psychiatric (nursing) program has become a potential program considered for agency development. We have seen an increase in questions regarding psychiatric nursing services for the patient suffering from bi-polar disorder with depression...
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Thu, Jun 7 2012
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Filed under: Medicare, iPad, Select Data, Compliance, Legislation, Z-PICs, MICs, RACs, MACs, Home Health Software, Homecare Software, HIPAA Compliant, Home Health Clinicians, OASIS Documentation, Homecare Coding, Home Care Coding Services
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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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Accurate coding with the highest level of specificity is required if an agency wishes to remain compliant and to retain revenues received. Creating and maintaining a strong code of conduct sends a powerful statement to employees, customers, and business...
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Thu, Mar 29 2012
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Filed under: RAC, MAC, Medicare, OASIS-C, HEAT, Z-PICs, MICs, RACs, MACs, Z-PIC
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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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Because we have received calls asking about RAC audits, we have included a PowerPoint regarding RACs and suggested below preparation you may consider doing NOW. We are also re-releasing segments of a prior ezine. Below are some questions that you may...
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Wed, Feb 29 2012
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Filed under: Medicare, Home Health, Home Care, Select Data, OASIS-C, Compliance, Coding, Z-PICs, MICs, RACs, MACs, Home Health Software
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Yes, it is true that on February 14, 2012, CMS Acting Head, Marilyn Traverner, told the press that CMS will “reexamine the timeframe” of implementation of ICD-10 CM. She stated the timeframe will be examined through the rule making process, but no word...
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Agency leaders know that now more than ever, coding is driving payment and is a focus of audit by RACs, MACs, and Z-PICs. It is imperative that the primary diagnosis, primary secondary diagnosis, and sequencing of all codes clearly delineate the picture...
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Fri, Feb 17 2012
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Filed under: Medicare, CMS, Home Health, Select Data, OASIS-C, ICD9-CM Coding, ICD-10-CM Coding, Z-PICs, MICs, RACs, MACs, Home Health Coding, CY2012, Home Health Software, VNAA's 30th Annual Meeting
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Among RACs, MACs, MICs, and Z-PIC concerns, along with new survey protocols, new CY 2012 regulations, the advent of 5010, Accountable Care Organizations, and looming ICD-10 CM, what tools can a leader utilize to help mitigate risk? One such tool is the...
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Thu, Jan 19 2012
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Filed under: Medicare, Home Health, Home Care, Select Data, OASIS-C, Compliance, CMS Guidelines, Coding, ICD-10-CM Coding, Z-PICs, MICs, RACs, MACs, CY2012, Home Health Software, (PIP), Performance Improvement Program
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RACs, MACs, Z-PICs, Part II of IV CERTS – (Comprehensive Error Rate Testing) To better calculate the performance of the FIs and MACs, as well as to look at the reasons for their errors, CMS decided to look at a number of additional rates. The additional...
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Thu, Jan 19 2012
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Filed under: Medicare, hipaa, Home Health, Select Data, Educational Videos, OASIS-C, Compliance, CMS Guidelines, HEAT, Z-PICs, MICs, RACs, MACs, HIPPA HITECH, Part II of IV
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RACs, MACs, Z-PICs, Part I of IV CMS has Unleashed the Auditors Annually, CMS receives 1.2 billion claims. That breaks down to 4.3 million claims per work day, 574,000 claims per hour, and 9,579 claims per minute. Fraud and abuse are on the rise and the...
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Thu, Jan 19 2012
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Filed under: hipaa, Home Health, Educational Videos, OASIS-C, Compliance, CMS Guidelines, HEAT, Z-PICs, MICs, RACs, MACs, HIPPA HITECH, CERTs, the HEAT, and now
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What are your agency case mix averages by admission: clinician: diagnosis? Do you know your top five diagnostic patient profiles? How do you set visit frequencies? Formula-based or what seems right? Are you making visits that have no impact on patient...
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Sat, Oct 15 2011
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Filed under: hipaa, CMS, Home Health, Compliance, Legislation, Surveys, CMS Guidelines, HEAT, Z-PICs, MICs, RACs, MACs, Z-Pics:The Auditors are Unleashed