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Richter ShareSource Blog

Understanding Ohio's Nursing Facility Medicaid Adjudication Process and What to do if you Receive a Medicaid Overpayment Review Letter

Posted by Candace Jones on Mar 21, 2017 9:34:10 AM

All skilled nursing facility (SNF) administrators should be aware of the state of Ohio Department of Medicaid (ODM) adjudication process, but many may not know that the findings of the state’s audit can – and should be – refuted.

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Topics: Medicaid Consulting, Revenue Cycle Management, Financial Consulting

Implementing QAPI Program Planning and Processes – the Key to Helping LTPACs Overcome Challenges and Thrive

Posted by Jennifer Leatherbarrow on Mar 20, 2017 12:34:07 PM

Setting your goals is a vital part of the Quality Assurance/ Performance Improvement (QAPI) process. The first step entails establishing thresholds. In order to determine your thresholds, you must first collect the relevant data. When collecting data, it is important to ensure that the data is meaningful and not erroneous. Once the appropriate data is gathered, you will use that information to identify a threshold. The QAPI process must include this step for establishing an acceptable threshold, target or goal. Although benchmarks can be set for any threshold, clinical benchmarks should be set based on the consideration of standards of care or best practice for that specific benchmark. Such information can be obtained through professional organizations, research and databases within your industry. Another good source of information is the Centers for Medicare and Medicaid Services (CMS) website.

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Topics: Clinical Consulting, QAPI Consulting

Understanding the Roles and Responsibilities of the Home Health Scheduler

Posted by Yolanda Riley on Mar 13, 2017 2:21:45 PM

What is a Home Health Scheduler?

In this blog, we shine the spotlight on home health, and specifically, the home health scheduler, a crucially important member of your agency team. We explain the roles that this person plays; how home health care in general is covered; how visits are scheduled; service limitations; and best practice tips for scheduling that enable home health schedulers to promote positive outcomes for your agency and its patients.

A home health scheduler is the primary gatekeeper for your agency, serving as the liaison between the agency, client, caregiver and the payer. Their primary function is to schedule and manage the flow of patient care, ensuring that quality service is provided and patient satisfaction met. The scheduler provides the scheduling and coordination of the daily schedules for the following within a home health agency:

  • RN case manager
  • LPN
  • OT, PT, ST
  • Home health aides
  • Social worker

Read our blog, Best Practices for Documenting Home Care Skilled Services to learn more about best practices for clinical documentation of services in a Home Health setting.  

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Topics: Home Health & Hospice

Implementing Performance Improvement Plans as a Part of a QAPI Program

Posted by Jennifer Leatherbarrow on Mar 8, 2017 11:23:00 AM

Note: Do you want to learn more about Quality Assurance and Performance Improvement (QAPI), or have questions about how QAPI can help your LTPAC facility? Read our blog: What IS QAPI? Your Guide to the new LTPAC and Skilled Nursing Facility Standard for Quality Assurance and Performance Improvement.

What is a Performance Improvement Project in a skilled nursing or LTPAC facility?

A Performance Improvement Project (PIP) is a focused effort on a specific problem in one area of a long term post acute care (LTPAC) facility or agency, or for the entity as a whole. The process involves methodical gathering of data to bring additional clarity to facility issues or problems. The facility initiates a PIP to examine and improve care and/or services in areas that the facility has identified as areas of concern. Areas of concern will vary depending on the type of facility or agency and the distinctive scope of services provided.

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Topics: Clinical Consulting, QAPI Consulting

Additional Development Request (ADR) Basics – Understanding How and Why They Are Used

An Additional Development Request (ADR), also known as an Additional Document Request, is issued for the purpose of reviewing documentation for specific issues as determined by the Centers for Medicare and Medicaid Services (CMS) or other governing agencies of the federal government.

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Topics: Clinical Consulting, Revenue Cycle Management, Financial Consulting

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