Is the new Plan of Care (POC) Requirement reason for alarm? QIRT explains what's actually new and what to do about it.
Plan of Care (PoC) Content Requirements: Something New is Old Again
Backlog to the Future? Part 3
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.
Backlog to the Future? Part 2
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 →
Plan of Care (POC) Regulation Change – One Good Thing to Start the New Year
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 →
Backlog to the Future? Part One: The State of ALJs
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 →
The Impact of Quality Reporting on Star Ratings
A tightly interwoven loop illustrates the impact of quality reporting on star ratings ... and the importance of the relationship between the two. Star ratings encourage providers to strive for higher levels of quality. They support consumers’ health care decision-making by providing easily recognizable differences in quality when selecting a health care provider. The higher the... Continue Reading →
TPE Update: The Only Constant is Change
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 →
It’s Alive! The Return of Pre-Claim Review… in the Form of Review Choice Demonstration
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 →
A Focus on PIPs (Performance Improvement Projects)
Effective QAPI can be useful to improve your agency outcomes and finances, but essential to QAPI is a focus on PIPs (Performance Improvement Projects).