PDGM Workgroup, Including QIRT Executives, Submit an Advisory Letter to CMS

PDGM Workgroup, including QIRT executives, submitted an Advisory Letter to Centers for Medicare & Medicaid Services (CMS). In a reply email on June 14, CMS expressed gratitude to the Workgroup for bringing their concerns to CMS' attention.

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 →

Cirque de Home Health: Juggling Payment Risks – TPE update

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 →

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 →

Valuing Quality Through Care Management

Care Management ensures the quality of patient care with measurable outcomes and Quality Cycle Management (QCM) Accomplish effective Care Management by using a multi-disciplinary team to provide coordinated care for high-risk patient populations. Quality Cycle Management (QCM) lays the foundation for the agency to provide Care Management. How? Through coordinated workflow processes and operations that follow... Continue Reading →

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