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Infographic | Top 6 Home Health Denial Reasons Based on Medical Review

Accuracy and oversight matter in home health billing. Agencies must be on top of their business practices to avoid denials. This includes managing detailed documentation procedures and the most accurate billing processes possible. Knowing the top reasons home health agencies receive denials based on medical review and how to avoid them will keep your agency on top of its reimbursement game. Check out our infographic to learn more.

What You Need to Know About Hospice Compare

Hospice Provider Preview Reports for the Hospice Item Set (HIS) became available through CASPER on June 1, 2017. Hospices can now see what their information looks like on CMS Hospice Compare, which went live on Aug. 16, 2017. This initiative was established as a requirement of the Hospice Quality Reporting Program established in the Affordable Care Act.

Harnessing CASPER Data to Improve Performance

Are you feeling overwhelmed with Certification and Survey Provider Enhanced Reporting (CASPER)? The sheer amount of complex data and varying reports can make the CASPER platform seem like a steep mountain to climb. Many providers simply lack the ability to effectively use the data CASPER offers for quality and process improvement on a consistent basis.

Using CASPER Reports to Improve Your Business

CASPER Reports hold useful information providers can leverage to improve their Five-Star Rating and Quality Measures. Unfortunately, obtaining these reports can take a long time and tie up resources. In this video, our compliance expert reviews the benefits of frequently checking CASPER Reports, the pain points of pulling the reports, and how eSolutions automates the report retrieval and delivery process.

How to Prepare for Pre-Claim Review

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

For providers who have yet to experience the Pre-Claim Review process, education and preparation are more crucial than ever. It's wise to ensure your staff and revenue cycle practices are fully equipped to handle any possible cash flow delay or drain on resources. Check out this short video outlining the most common Pre-Claim Review challenges and how eSolutions can assist in keeping your revenue cycle in the best shape possible.

REMINDER: Home Health Probe and Educate Round 2 to Begin Jan. 19

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.

Pre-Claim Review Update

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

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.

What's the Latest on Pre-Claim Review?

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

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 pushed back to April 1, 2017 in Florida, and delayed in Texas, Michigan, and Massachusetts until further notice. What does this mean for you, and how can you best prepare for PCRD?

Improving Your Nursing Home Star Rating Infographic Series - Part 3

In 2016, CMS added new quality measures to determine a nursing home's 5-star rating on the Nursing Home Compare section of Medicare.gov. These measures are based on Medicare claims data and the minimum data set (MDS), and include statistics such as rehospitilization rate and emergency room use.

Improving Your Nursing Home Star Rating Infographic Series - Part 2

CMS uses specific quality measures to determine a nursing home's 5-star rating on the Nursing Home Compare section of Medicare.gov. These measures are based on Medicare claims data and the minimum data set (MDS), and include statistics such as rehospitilization rate and emergency room use.