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OIG report suggests CERT data could identify ‘high-risk’ home health agencies

A report from the Department of Health & Human Services (HHS) Office of Inspector General (OIG) recommends using Comprehensive Error Rate Testing Data (CERT) to identify “high-risk” home health agencies to help reduce improper payments and agency error rates. CMS didn’t agree with the recommendation, however. Instead CMS points to CMS’ fraud prevention system, targeted […]

Did you know? 2019 Revenue Integrity Symposium is this October

October 15-16, 2019 | Orlando, FL The Revenue Integrity Symposium is the can’t-miss event for revenue integrity, revenue cycle, and Medicare compliance education and high-level networking for acute and long-term care professionals. Learn from trusted experts with cutting-edge regulatory insight that will arm you with the tools you need to take 2020 by storm. By […]

MDS 3.0 RAI Manual Update

The new version of the MDS 3.0 RAI Manual, v1.17.1 are effective October 1, 2019 and  incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios […]

2020 National Provider Enrollment Forum Speakers

We are seeking speakers to present at the 2020 National Provider Enrollment Forum, to be held April 19-22 in New Orleans at the Sheraton New Orleans Hotel. Click here to view and complete the speaker application. Presenters must complete the application prior to the September 30 deadline. Accepted speakers and co-speakers receive free admission to […]

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OIG releases new report, prompting CMS to publish new fact sheet for 3-day rule

The HHS Office of Inspector General (OIG) has released the “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations” which includes eight recommendations to CMS regarding Medicare Parts A and B: CMS should analyze the potential impacts of counting time spent as an outpatient toward the 3-night requirement for skilled nursing […]

PDPM Q&A: Payment overview and billing

CMS has released its FAQ sheet on PDPM: Q. What is PDPM? A. The Patient Driven Payment Model (PDPM) is a new case-mix classification system for classifying skilled nursing facility (SNF) patients in a Medicare Part A covered stay into payment groups under the SNF Prospective Payment System. Effective beginning October 1, 2019, PDPM will […]

CMS releases tables detailing the 2019 quality measures for home health

Source: Home Health Line CMS has published updated details on potentially avoidable events, process and outcome measures for 2019. The updated tables also include details on star-ratings measures and quality measures new to Home Health Compare in 2019. Claims-based outcome measures “Medicare spending per beneficiary” and “Discharge to community” are joining the ranks of publicly […]

Intake and output monitoring

You should monitor residents who have fluid imbalances or are at high risk of dehydration by calculating intake and output (I&O) each shift.