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 →
A tightly interwoven loop illustrates the impact of quality reporting on star ratings ... and the importance of the relationship between the two. Star ratings encourage providers to strive for higher levels of quality. They support consumers’ health care decision-making by providing easily recognizable differences in quality when selecting a health care provider. The higher the... Continue Reading →
Let's discuss the RCD implementation delay. The Review Choice Demonstration (RCD) for Home Health Services was scheduled to begin in Illinois on December 10, 2018. Numerous CMS webinars, Palmetto GBA webinars, and a CMS Open Door Forum all said so. However, that date seems to be a mirage, at least for the present time. Due... Continue Reading →
Yet Another Update to TPE (Targeted Probe and Educate) THIS JUST IN! (This post updates a blog written and published on 11/8/18) Medicare Administrative Contractor (MAC) CGS Administrators has just posted its first update to Targeted Probe and Educate (TPE) activity in nearly a year, and immediately updated it. Four more areas to receive additional... Continue Reading →
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 →
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 →
By Corinne Kuypers-Denlinger, Vice President, Post-Acute Care Growth Strategies, QIRT. Originally published in the e-newletter of the Illinois HomeCare & Hospice Council This is the first in a three-part series of articles about outsource coding and OASIS review. The purpose of this series is to help home health and hospice agencies determine if outsourcing this critical business... Continue Reading →
Implemented correctly, effective QAPI can be useful to improve your agency outcomes and finances. QIRT experts have outlined three major effective QAPI concepts that we recommend you remember above all.