The Consistency of TPE Failure Rates

Home health agencies undergoing TPE reviews continue to fail at impressive rates for the same reasons as previous reviews. Let's talk about the consistency of TPE failure rates and how they link to RCD, PDGM, and more.

RCD: More on the CMS FAQs Update

Last week, CMS updated its Frequently Asked Questions (FAQ) on the pending Review Choice Demonstration (RCD) project. Some of these merit additional scrutiny and comment since the selection window (via Palmetto GBA’s eServices portal) has started for Illinois home care agencies. Taken from the “Review Choice Demonstration (RCD) for Home Health Services Frequently Asked Questions (FAQs)”, updated 4/18/19.... Continue Reading →

RCD: CMS FAQs Add Some Clarity

Last week, CMS updated its Frequently Asked Questions (FAQ) on the pending Review Choice Demonstration (RCD) project. Some of these merit additional scrutiny and comment since the selection window (via Palmetto GBA’s eServices portal) has started for Illinois agencies. From the “Review Choice Demonstration (RCD) for Home Health Services Frequently Asked Questions (FAQs)”, updated 4/18/19: Question... Continue Reading →

Another Home Health “Compare” to Make

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 →

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 →

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