What about UPICs? RCD starts in IL on 6/1. QIRT has some questions on how this may affect other medical review activity that is occurring in an RCD state.
CMS announced yesterday that the Review Choice Demonstration (RCD) project will begin in Illinois on June 1, 2019. Prepare now with QIRT's support choices: Readiness Audits, Complete Guides, and a Team of Experts.
The Requirements for Long-term Viability in Home Health The following article, written by Corinne Kuypers-Denlinger, Vice President, Post-Acute Growth Strategies at QIRT, was originally published in HomeCare Magazine. Kuypers-Denlinger explores the importance of complete reassessment by home care agencies in advance of the new Patient Driven Groupings Model (PDGM). Agencies will find that they must... Continue Reading →
In reviewing many home health denials, medical reviewers often identify patterns that highlight areas of focus. One of these patterns relates to therapy requirements. Agencies must have orders for therapy and show therapy service is skilled, reasonable, and necessary. In addition, the requirement for a 30-day therapy reassessment must occur. And it is this requirement... Continue Reading →
Is the new Plan of Care (POC) Requirement reason for alarm? QIRT explains what's actually new and what to do about it.
Home care agencies who have received additional development requests (ADRs) are experiencing an ever-increasing ALJ backlog. The following is the final part of a 3-part series on the current state of ADRs and the ALJ backlog.
Home care agencies who have received additional development requests (ADRs) are experiencing an ever-increasing ALJ backlog. The following is part 2 of a 3-part series on the current state of ADRs and the ALJ backlog. Find Part One here. As we mentioned last week, a federal judge ruled that OMHA must seek to reduce the ALJ backlog... Continue Reading →
CMS has posted a Plan of Care (POC) Regulation Change. With all the pending changes coming to home health for 2020 with Patient Driven Grouper Model (PDGM) and pending Review Choice Demonstration (RCD), it may be easy to overlook one earlier change affecting home health reviews and denials that just went into effect. Finalized in... Continue Reading →
Home care agencies who have received additional development requests are experiencing an ever-increasing ALJ backlog. An additional development request (ADR) is generated to request documentation from a provider to assist with adjudicating a Medicare claim. Since 2010, the number of claims awaiting an Administrative Law Judge (ALJ) hearing has steadily climbed, along with the wait time for... Continue Reading →