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 →
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 →
THIS JUST IN - TPE UPDATE! Medicare Administrative Contractor (MAC) CGS Administrators has just posted its first update to Targeted Probe and Educate (TPE) activity in nearly a year. Four more areas will receive further scrutiny. These TPE updates are in addition to Home Health Eligibility & Medical Necessary and Length of Stay (LOS) with... 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.
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.
Introducing the Low Volume Appeals Settlement Process, also known as LVA. This is a new option for agencies who are waiting for ALJ hearings or MAC/DAB reviews. QIRT highly recommends you take advantage of this opportunity to settle fully denied claims. CMS has just provided a new avenue for agencies stuck waiting for Administrative Law... Continue Reading →
Home Health Care News consulted Reimbursement Recovery and Appeals Director, Joe Osentoski for his knowledge of CMS' Targeted Probe and Educate audits. In an article dated December 11, 2017, Carlo Calma detailed some of the regulation changes brought about by CMS and spoke to experts about the impacts they are seeing in the industry.