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 →

Cirque de Home Health: Juggling Payment Risks – TPE update

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 →

Valuing Quality Through Care Management

Care Management ensures the quality of patient care with measurable outcomes and Quality Cycle Management (QCM) Accomplish effective Care Management by using a multi-disciplinary team to provide coordinated care for high-risk patient populations. Quality Cycle Management (QCM) lays the foundation for the agency to provide Care Management. How? Through coordinated workflow processes and operations that follow... Continue Reading →

The RAC is Back.

We can now confirm to home health agencies: the RAC is back. More than a year after being given the okay to restart medical review activities, the Recovery Audit Contractor (RAC) for home health has posted the first Work Issue. During the hiatus of reviews, CMS updated and "improved" the RAC's process for reviews and follow-up.... Continue Reading →

Low Volume Appeals (LVA) Initiative Settlement Option, Part 3

The Low Volume Appeals Settlement Process, also known as LVA, is a new option for agencies who are waiting for ALJ hearings or MAC/DAB reviews. Take advantage of this opportunity to settle fully-denied claims. When to apply for Low Volume Appeals Settlement The dates to apply for this new CMS initiative are here! Based on... Continue Reading →

Low Volume Appeals (LVA) Settlement Option – Part 1

Introducing the Low Volume Appeals Settlement Process, also known as LVA. This is a new option for agencies who are waiting for ALJ hearings or MAC/DAB reviews. QIRT highly recommends you take advantage of this opportunity to settle fully denied claims.   CMS has just provided a new avenue for agencies stuck waiting for Administrative Law... Continue Reading →

Why Your P&P Manual Must be as Unique as Your Agency

With the new Conditions of Participation (CoPs) going into effect January 13th, QIRT consultants have been receiving multiple calls from current and potential clients requesting that we provide them with a new policy and procedure manual that covers the new COPs. On the surface, this seems like an easy enough request - for a fee, QIRT... Continue Reading →

Emergency Preparedness Reqs Begin November 15

A number of months ago, CMS released the Interpretive Guidelines on Emergency Preparedness for all providers.  Many have not heeded the warning and we are now at the 11th hour. Your agency must have all plans in place and all drills completed by November 15, 2017. If you have not begun the process, you are not... Continue Reading →

It’s Almost Flu Season! How Do I Manage Employee Vaccination?

Did you know influenza is the third leading cause of death in NYC for 10 years in a row? Flu vaccination programming is a crucial piece of compliance that is of utmost importance in the home care and hospice industries. QIRT Clinical consultants spend hours out in the field working hands-on with home care and hospice... Continue Reading →

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