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 →
Let's discuss the RCD implementation delay. The Review Choice Demonstration (RCD) for Home Health Services was scheduled to begin in Illinois on December 10, 2018. Numerous CMS webinars, Palmetto GBA webinars, and a CMS Open Door Forum all said so. However, that date seems to be a mirage, at least for the present time. Due... Continue Reading →
Yet Another Update to TPE (Targeted Probe and Educate) THIS JUST IN! (This post updates a blog written and published on 11/8/18) Medicare Administrative Contractor (MAC) CGS Administrators has just posted its first update to Targeted Probe and Educate (TPE) activity in nearly a year, and immediately updated it. Four more areas to receive additional... Continue Reading →
After a pause of more than a year, CMS will soon resume the pre-claim review (PCR) demonstration project in five selected states. The pre-claim review is now called Review Choice Demonstration (RCD) for Home Health Services and there are some changes. First of all, tweaks in the new process "offer more flexibility and choice for providers,... Continue Reading →
The deadline to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative was extended to June 8, 2018. QIRT strongly recommends home health agency participation in the LVA Settlement.
Fresh from CMS: a Low Volume Appeals Initiative (LVA) extension. TCMS has extended the period to use this opportunity to settle claims. What's New in LVA? 3/29/2018- The deadline to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative has been extended to June 8, 2018. Appellants that meet the eligibility criteria (and have... Continue Reading →
The formal addition of education in the TPE process after the results of the probe are summarized gives detail and suggestions on the agency's actual review findings to support improvement.
Important reminder that Thursday, March 9, 2018, is the final day for appellants with National Provider Identifiers (NPIs) ending in an even number (0, 2, 4, 6, 8) to submit an expression of interest (EOI) for the Low Volume Appeals (LVA) Initiative.
The Low Volume Appeals Settlement Process, also known as LVA, is a new option for agencies who are waiting for ALJ hearings or MAC/DAB reviews. Take advantage of this opportunity to settle fully-denied claims. When to apply for Low Volume Appeals Settlement The dates to apply for this new CMS initiative are here! Based on... Continue Reading →