The Requirements for Long-term Viability in Home Health The following article, written by Corinne Kuypers-Denlinger, Vice President, Post-Acute Growth Strategies at QIRT, was originally published in HomeCare Magazine. Kuypers-Denlinger explores the importance of complete reassessment by home care agencies in advance of the new Patient Driven Groupings Model (PDGM). Agencies will find that they must... Continue Reading →
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 →
Is the new Plan of Care (POC) Requirement reason for alarm? QIRT explains what's actually new and what to do about it.
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.
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 →
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 →
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 →
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 →
Let's discuss the RCD implementation delay. The Review Choice Demonstration (RCD) for Home Health Services was scheduled to begin in Illinois on December 10, 2018. Numerous CMS webinars, Palmetto GBA webinars, and a CMS Open Door Forum all said so. However, that date seems to be a mirage, at least for the present time. Due... Continue Reading →