Healthy Revenue Cycle: QIRT Financial Fit List 2018

Healthy revenue cycle is crucial to a post-acute agency's overall fitness.  This is even truer now, with the new payment model on the horizon. QIRT's financial experts have created a "fitness routine" to help strengthen your agency. Make use of QIRT's Financially Fit List for toning processes and preparing benchmarks.  What does your agency's revenue... Continue Reading →

Low Volume Appeals (LVA) Initiative Settlement Option – Part 2

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.  

Responses to 11/10 Scenarios; New Scenarios for 11/17/14

Responses Scenarios for 11/10/14 Question:  How do I code a patient who had a failed skin graft? Answer: There are two codes for rejection or failure of a skin graft.  Code 996.52 is used for a rejection of a natural skin graft and 995.55 is used for dislodgment, displacement, failure, poor incorporation or shearing of an... Continue Reading →

CY 2015 Proposed Rule, how it could affect your agency, and why you NEED to make a comment to CMS…

Point changes, case-mix weight (CMW) changes, and OASIS submission implementation requirements could have a huge monetary impact on your agency.   There is potential to lose millions of dollars in revenue if the proposed rule is implemented as it has been issued. Case-mix weights are continuing on the rebasing train. CMS (Centers for Medicare and Medicaid... 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 →

CMS releases 2014 HHPPS Final Rule

Late last week CMS published the rule that sets the 2014 Medicare home health payment rates.  The final rule is a slight improvement over the proposed rule (a net reduction of 1.05% instead of the proposed 1.5%) that was issued last June.  The change from proposed to final is due modifications of the case-mix recalibration,... Continue Reading →

CMS Proposed Home Health Payment Rates for 2014

Late last week the Centers for Medicare and Medicaid Services (CMS) released the proposed payment rates for FY2014. The proposal includes rebasing as well as significant changes in case mix weights. According to CMS, the changes will result in an overall payment reduction of 1.4% in 2012. William A. Dombi, the Vice President for Law... Continue Reading →

CMS is Requiring HIPPS Codes on Medicare Advantage Claims

The following article was published on the National Association for Home Care and Hospice (NAHC) website on June 19, 2013: Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage (MA) claims. The Centers for Medicare & Medicaid Services (CMS) has instructed... Continue Reading →

Happy May Day! CMS is delaying implementation of phase 2 PECOS edits

CMS has announced that, due to technical issues, implementation of the phase 2 ordering and referring denial edits is being delayed. These edits would have checked claims for approved or validly opted out physician or non-physician who is an eligible specialty type with a valid National Provider Identifier (NPI). If either of these were missing... Continue Reading →

Up ↑

%d bloggers like this: