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.

RCD: The Choices Made

The CMS Review Choice Demonstration (RCD) begins June 1st, and our experts dive into RCD: the choices made during the selection period. Now that the CMS Review Choice Demonstration (RCD) project has arrived in Illinois, Palmetto GBA posted an item of interest that shows the breakdown of home health agency selections. Here are the posted... Continue Reading →

RCD and UPICs – Part 2

QIRT Alerts' April 9th blog posed questions about the relationship between RCD and UPICs. QIRT experts asked: what happens when you have a Review Choice Demonstration (RCD) project and are under the Unified Program Integrity Contractor (UPIC) reviews? And we followed that with many more questions. Since then, "The Review Choice Demonstration HH Team" provided... 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 →

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