Revenue Cycle Management is all about process. If you understand the process, you can manage both the process and those employees who may have a role in it.
Topics: Revenue Cycle Management
Utilization of Electronic Health Record (EHR) has opened the door for many persons/facilities/organizations to become active in customizing and/or adding items to their database wherever possible. The ability to add facility or organizational specifics has enabled uniformity and consistency with the building of templates/pick-list(s) and libraries. It can be either the time saving tool everyone loves or a problematic add-on that can have both monetarily or regulatory implications.
Do you wish you had a nickel for every family member who said, “The Doctor said Medicare would pay for everything.”?
If only that was true. Prospective residents and family members are often in a whirlwind of emotion and confusion when contemplating Post-Acute care options. Between trying to visit someone in the hospital, pay attention to the recommendations of professional caregivers, consider choices to be made and then remembering to pick up ‘Jimmy’ after soccer practice, it can be just too much.
It seems as though changes in our industry are coming fast and furious now. The implementation of the Affordable Care Act (ACA) has resulted in an increased scrutiny of our processes. With a larger focus on audits and overpayments, we are facing a future with a much different payment landscape – including bundled payment programs based on clinical outcomes.
The early detection and treatment of sepsis is exceedingly important. So let's start off with the definition of sepsis:
Topics: Clinical Consulting
In accordance with Section 6106 of the Affordable Care Act, the Center for Medicare and Medicaid Services (CMS), working towards greater accountability and accuracy, has introduced a means for nursing facilities to report electronically staffing information which will eventually be utilized in the determination of 5 Star Ratings on quality care. This system is known as the “Payroll-Based Journal” (PBJ), and is mandated to start on July 1, 2016.
As with everything else these days, paperless and electronic are the way to go when it comes to receiving payments and remittances from your third party payors. As cash flow is usually a top priority with healthcare providers, the quicker the funds get to them and the quicker billers can respond to denials and turn them back around for payment the better.
The Centers for Medicare and Medicaid Services (CMS) released a new regulation on February 2, 2016 requiring patients who receive Medicaid benefits for home healthcare services to have a face-to-face visit.
Repeatedly, I hear MDS Nurses stating that it’s “not their job” to oversee or manage the diagnosis. Honestly, as a previous MDS Nurse, I cannot believe there is even a question as to who is responsible. So, I ask them: Who signs Section I of the Minimum Data Set (MDS)?
Topics: Clinical Consulting
On February 11th, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Overpayment Reporting Rule. Originally introduced by the Affordable Care Act (ACA) in 2010 as a means to combat fraudulent overpayments and ultimately protect the Medicare Trust, this rule clarifies the requirements for reporting and returning “self identified” overpayments to Medicare, and the timeframes in which providers are expected to do so.
In Part One QAPI for the LTPAC in 2016, I reviewed the definition of QAPI and discussed the 5 elements of QAPI. Part Two of this series is going to focus on the twelve steps of QAPI. In order for any QAPI process to be successful, it is recommended that you use the twelve steps as developed by the Centers for Medicare and Medicaid Services (CMS).