If you live in Illinois, Florida, Texas, Michigan or Massachusetts, you are the lucky home health care workers who get to pilot out the Medicare pre-claim review program. Due to opposition from 116 House of Representative members and 6 Senators so far, CMS has modified their program from the original conceived idea of “a prior […]

The Jimmo v. Sebelius settlement agreement came about in 2013 when the US District Court for the District of Vermont approved a settlement between the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare Advocacy (CMA). In a nutshell, CMA’s position was that Medicare beneficiaries were being denied skilled care because of […]

First of all, don’t panic. This latest round of ADRs (additional documentation requests) has been brought about by the IMPACT act. These are “probe and educate” reviews that all agencies are or will be subjected to. It does not mean that you have done anything wrong. Basically, the Fiscal Intermediaries are required to select 5 […]

We recently shared with you an upcoming change to the way homebound status will be documented in our next update. We hope that you had the opportunity to digest this information. There’s one more important change that we would like to let you know about. It pertains to the 30-day reassessment alerts. Presently, the reassessment […]

Even though homebound status documentation in therapyBOSS already provides clinicians with means to reflect the patient’s homebound status in a compliant manner, we recognize that monitors are looking for any and every excuse to substantiate denials. In our continuous effort to help clinicians easily create 100% defensible documentation, we are revising the Homebound Status section […]

Ok guys – there’s a new Proposed Rule for Home Health for 2016. We have read through all 236 pages of this proposed rule and have cut it down to several smaller, digestible nuggets for you. Here we go… PPS / Payment Adjustments Case-mix points are being re-calibrated again using 2014 cost report data. 39 […]

Palmetto GBA updated their PT and OT local coverage determinations (LCDs) on 3/12/15 to include provider education and guidance regarding documentation of restorative versus maintenance therapy. The PT utilization guideline states “Whether the plan is rehabilitative/restorative or maintenance should be indicated on the CMS-485 or on the OASIS M1800-M1910 with reference to ADL/IADL’s and current […]

Attention all agencies! Urgent news regarding OASIS transmissions! CMS is converting to the Assessment Submission and Processing (ASAP) System at the end of the year, which will change submission from state databases directly to the federal database. There will be a system shut down from 6:00 PM (ET) on December 26, 2014 through 11:59 PM […]

2015 is shaping up to be a big year for home health regulatory changes. The latest change is in the OASIS data set. CMS has been gearing up for the ICD-10 conversion for some time now and had updated the OASIS document to allow for ICD-10 codes and took the opportunity to clarify some of […]