TMF Health Quality Institute, under contract with CMS, compiles data about claim trends called the Program for Evaluating Payment Patterns Electronic Report (PEPPER). A CEO, President, Administrator or Compliance Officer of your organization can browse to the PEPPER Resources Portal with your home health agency’s basic demographics, CMS certification number (or PTAN) and a Validation […]

As every home health therapist knows, Medicare requires a 30-day reassessment at least every 30 days but where did this requirement come from and why is it so important? A Brief History In the 2011 Home Health Final Rule, the Centers for Medicare & Medicaid Services (CMS) proposed a change to the frequency of therapy […]

Wrong and wrong. While it’s true that starting April 1st the pre-claim review demonstration has been paused before it could start in Florida, and that pause has been extended to Illinois for at least 30 days, this is not the definitive end of the pre-claim process. And it should not be an excuse to relax […]

If you haven’t yet, read our article on preparing for home health Pre-claim Review (PCR) for helpful tips and tools to get started. Stay tuned for more content, including how to appeal a non-affirmed pre-claim decision. In this post, I will take you through the pre-claim submission process with special focus on Palmetto GBA’s eServices […]

You’ve heard the warnings. You live in a state that’s getting ready to adopt CMS’ pre-claim review (PCR) program. But what do you do now? We here at therapyBOSS would like to share a few helpful tips from our home health clients who have gone through this process. Having observed their challenges, the first thing […]

On January 13, 2017 CMS published the final rule for the Conditions of Participation (CoPs) for Home Health Agencies (HHAs). According to the document, the main reason for the change is to update the regulations for home health and shift the focus of home health to increase patient participation, encourage interdisciplinary communication, and ensure better […]

For dates of service on or after January 1, 2017, home health agencies will have four new G-codes to contend with for skilled nursing services. These new codes will replace retiring codes G0163 and G0164. The new codes are: G0493 – Skilled services of a registered nurse (RN) for the observation and assessment of the […]

OASIS-C2 becomes effective for (M0090) Date Assessment Completed dates on or after January 1, 2017. I am here to tell you about the upcoming changes which, at a higher level, aim to more closely align the Home Health OASIS data set to other post-acute care standardized assessment data sets. So what’s new? There are actually […]

Greetings everyone. We’re all busy so let’s keep this one brief. There are a few new items that have come up for pre-claim review that looked important enough to share immediately so here they are. There is an updated start date for the pre-claim review demonstration in Illinois. That date is August 3, 2016. The […]