Low Volume Appeals (LVA) Initiative Settlement Option, Part 3

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 →

Responses for 11/17; New scenarios for 12/1

Good Monday morning, I hope everyone enjoyed the Thanksgiving holidays last week!  Here are the responses from 11/17 questions and scenarios. OASIS C1/ICD9: What does the home health resource group, or HHRG, measure? The Medicare Home Health PPS recognizes that different patients use different amounts of resources. The system attempts to predict patient resource use... Continue Reading →

What is Considered a Patient’s Place of Residence?

A patient's residence is wherever he or she makes his or her home.  This may be their own home, an apartment, a relative's home, a facility for the aging, or some other type of institution.  An institution can't be considered a patient's residence if the institution meets the requirements of §§1861(e)(1) or 1819(a)(1) of the Act.  This... Continue Reading →

What does CMS say about Medical Supplies in Home Health?

The law requires all medical supplies (routine and nonroutine) bundled to the agency while the patient is under a home health plan of care. The agency that establishes the episode is the only entity that can bill and receive payment for medical supplies during an episode for a patient under a home health plan of... Continue Reading →

Breaking Medicare Benefits Manual down into bite-sized pieces.

My goal is for each of you to have a working understanding of the Medicare Benefits Manual. I plan on taking parts of the manual and breaking it down into segments. This will enable you have small portions of information to read, which I’ve found is MUCH easier than trying to read a 100-page document... Continue Reading →

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