Beginning January 19 of 2017, all states will participate in the Home Health Probe and Educate Review Round 2, a review that determines if home health agencies (HHAs) meet the compliance requirements for certification or recertification, patient eligibility, payment criteria, coding and medical necessity, as outlined in CMS-1611-F. The Home Health Probe and Educate Review includes all states, except those actively involved in the Home Health Pre-Claim Review Demonstration.
An efficient revenue cycle solution is highly dependent on the quality of your company’s clearinghouse. First and foremost, in order to identify which clearinghouse is the best fit for your company, it’s important to recognize what your billing system may be lacking. Here are some key features
you should be on the lookout for.
On January 1st, the OASIS-CR is going into effect. This will mean the addition of three new standardized items (M1028, M1060, GG0170c), along with modification to select medication and integumentary items. This is being done in an effort to standardize with other post-acute settings of care (M1311, M1313, M2001, M2003, and M2005).
The Pre-Claim Review delay is coming to an end. On December 19th, CMS announced that the demonstration will expand to Florida on, or after April 1, 2017. Since the delay announcement, CMS and the Medicare Administrative Contractors (MACs) have provided education to home health providers on how to submit pre-claim review documentation, and will continue that process to ensure Florida is ready.
On December 2nd, the Centers for Medicare & Medicaid Services reported that Pre-Claim Review Demonstration affirmation rates had hit a high of 87% in the state of Illinois. While 83% of these requests were fully affirmed, another 4% received a partially affirmed decision. This is welcome news to providers who saw only a 66% affirmation rate during the first eight weeks of the program.
Healthcare providers are no strangers to the RAC (Recovery Audit Contractor) audit program. Since 2009, the Centers for Medicare & Medicaid Services (CMS) has awarded contracts to private companies to review Medicare claims and recover potential overpayments. We’ve all recently had a welcome break from RAC audits, but that’s about to change. Last month, CMS awarded new contracts to several companies, and a new wave of audits is set to begin as early as January!
The gift giving season is officially here. In addition to assisting with your claims management, we also want to try and make your holiday season a little less stressful by providing some unique gift ideas for the healthcare professional, or professionals in your life. So whether you want to show appreciation for your employees, got roped into a Secret Santa, or even if you're a patient who stumbled upon this post, you're sure to find something good.
The Pre-Claim Review Demonstration (PCRD) that began in Illinois back in August is off to a less than ideal start. Because of this, the demonstration has been delayed in Florida, Texas, Michigan and Massachusetts until further notice. What does this mean for you, and how can you best prepare for PCRD?