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 →

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 →

Backlog to the Future? Part One: The State of ALJs

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 →

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