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.

Healthy Revenue Cycle: QIRT Financial Fit List 2018

Healthy revenue cycle is crucial to a post-acute agency's overall fitness.  This is even truer now, with the new payment model on the horizon. QIRT's financial experts have created a "fitness routine" to help strengthen your agency. Make use of QIRT's Financially Fit List for toning processes and preparing benchmarks.  What does your agency's revenue... Continue Reading →

170 codes no longer case-mix-What do we do?

Much of my day is spent perusing Medicare regulations and Q&As, OASIS regulations and Q&As, ICD coding regulations, home health listservs, home health blogs and other social media outlets pertaining to home health care. Several months ago, there was some buzz about the Home Health PPS changes that would go in to effect on January... Continue Reading →

CMS is Requiring HIPPS Codes on Medicare Advantage Claims

The following article was published on the National Association for Home Care and Hospice (NAHC) website on June 19, 2013: Effective July 1, 2013 home health agencies will be required to include a Health Insurance Prospective Payment System (HIPPS) code on Medicare Advantage (MA) claims. The Centers for Medicare & Medicaid Services (CMS) has instructed... Continue Reading →

Happy May Day! CMS is delaying implementation of phase 2 PECOS edits

CMS has announced that, due to technical issues, implementation of the phase 2 ordering and referring denial edits is being delayed. These edits would have checked claims for approved or validly opted out physician or non-physician who is an eligible specialty type with a valid National Provider Identifier (NPI). If either of these were missing... Continue Reading →

CMS: April 2013 Home Health Claim Hold Lifted

On April 17, 2013, the Centers for Medicare and Medicaid Services (CMS) directed its Medicare claims administration contractors to release all claims into processing that they have been holding as a result of technical issues associated with the April 2013 quarterly systems release. For more information, go to the CMS website. Until next time, M

CMS technical issues still unresolved-final claims remain on hold

CMS’ April 15, 2013 deadline to lift the hold on all home health final claims has come and gone with no fix for the technical issues. CMS sent a message via the Medicare administrative contractor (MAC) email list on April 16th stating that claims were still being held due to “technical issues with certain parts... Continue Reading →

Sequestration impacts Home Health and Hospice reimbursement

On March 8, 2013, CMS announced that all Medicare FFS claims with dates of service or dates of discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment due the sequestration order issued by President Obama on March 1, 2013 as required by law. William Dombi, Vice President for... Continue Reading →

PECOS edits to begin May 1, 2013

Starting May 1, CMS will deny home health claims where the physician on the claim didn’t have an enrollment record in the provider enrollment, chain and ownership system (PECOS). CMS issued MLN Matters article SE1305 which announces the implementation of the PECOS edits and summarizes the process. The article can be found here: MLN Matters... Continue Reading →

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