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Richter ShareSource Blog

Targeted Probe and Educate – Appeal Options and Recommendations

In recent blogswe outlined medical Medicare review strategies; explained probe and educate (PE), as well as Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; we offered strategies for preparing and submitting TPE documentation; we outlined the TPE claims review process; and we highlighted top hospice TPE denial reasons. In this blog, we will share some TPE appeal options and recommendations.

If your hospice agency’s TPE claim is denied or partially denied, you can utilize the 5 Levels of Appeal process. We explain each level in detail below.
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Topics: Home Health & Hospice

An LTPAC Checklist to Promote Business Office Manager (BOM) Success

Posted by Candace LaRochelle, Revenue Cycle Manager on Oct 26, 2018 2:42:35 PM

To all of the great BOMs out there in the long-term post-acute care (LTPAC) realm, let me say, thank you! You are valued employees in skilled nursing. When one considers everything that you do, it’s obvious that BOMs wear many hats! You must effectively manage and oversee the bookkeeping function, manage and oversee patient accounts, recruit, select, hire, train, evaluate, counsel and supervise business office staff, manage and operate within budgetary parameters, and exhibit excellent customer service and a positive attitude toward residents and families. 

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EMPLOYEE ENGAGEMENT – AN ORGANIZATIONAL-WIDE PRIORITY AND EFFORT

Posted by Reba Allison, BCP, Director of Human Resources on Oct 26, 2018 1:45:52 PM

Employee engagement is not a human resources thing, it is not a CEO thing, and it is not an administrative assistant thing. In a long-term post-acute care (LTPAC) organization, there should be a multitude of individuals that must become the “drivers” of cultivating sustainable change when it comes to employee engagement. 

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Topics: Employee Engagement

Top Hospice Targeted Probe and Educate Denial Reasons

In recent blogswe outlined medical Medicare review strategies; explained probe and educate (PE), as well as Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; we offered strategies for preparing and submitting TPE documentation; and we outlined the TPE claims review process. In this blog, we will share some of the top hospice agency TPE denial reasons.

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Topics: Home Health & Hospice

Navigating the Targeted Probe and Educate (TPE) Claims Process

In recent blogs, we outlined medical Medicare review strategies; probe and educate (PE); we explained Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; and we offered strategies for preparing and submitting TPE documentation. In this blog, we will share tips on navigating the TPE claims review process.

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Topics: Home Health & Hospice

Preparing and Submitting Documentation for Targeted Probe and Educate, Medicare’s New Medical Review Strategy

In recent blogs, we outlined medical Medicare review strategies, probe and educate (PE), and we explained Targeted Probe and Educate (TPE), Medicare’s new medical review strategy. In this chapter, we will share tips on preparing and submitting your TPE documentation.

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Topics: Home Health & Hospice

Understanding Targeted Probe and Educate – Medicare’s New Medical Review Strategy

In 2015, the Centers for Medicare and Medicaid Services (CMS) introduced the Probe and Educate (PE) strategy, first to hospitals and then to home health care agencies. With this new strategy, five claims were selected from every hospital and home health care provider. If a claim was denied, one-on-one education was offered in an effort to prevent future errors.

Targeted Probe and Educate (TPE) is a result of the positive outcomes that were generated through the PE strategy. Although hospice agencies were not included in the PE strategy, TPE was expanded to all Medicare service providers in October 2017. Unlike other strategies, with TPE, your agency will only receive an Additional Development Request (ADR) if it is shown through data analysis that you may be doing something improperly which could result in an improper Medicare payment.

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Topics: Home Health & Hospice

The Proposed Patient-Driven Payment Model (PDPM): 10 Things You Need to Know

Posted by Jennifer Leatherbarrow, RN, BSN, RAC-CT, QCP, CIC on Jun 28, 2018 9:04:00 AM

In April 2018, the Centers for Medicare and Medicaid Services (CMS) threw yet another curveball at (MDS) coordinators and skilled nursing facilities (SNFs) across the country. CMS’ original plan to introduce RCS-1 (resident classification system, the proposed new federal payment system) was overturned and replaced by the now proposed patient driven payment model (PDPM). This new payment model does have similarities to the previous RCS-1, but there were improvements made to increase payment accuracy.

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Topics: Regulatory Changes, News & Events, Clinical Consulting