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 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 →
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 →
What about UPICs? RCD starts in IL on 6/1. QIRT has some questions on how this may affect other medical review activity that is occurring in an RCD state.
CMS announced yesterday that the Review Choice Demonstration (RCD) project will begin in Illinois on June 1, 2019. Prepare now with QIRT's support choices: Readiness Audits, Complete Guides, and a Team of Experts.
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 →