Home Health Care News consulted Reimbursement Recovery and Appeals Director, Joe Osentoski for his knowledge of CMS' Targeted Probe and Educate audits. In an article dated December 11, 2017, Carlo Calma detailed some of the regulation changes brought about by CMS and spoke to experts about the impacts they are seeing in the industry.
CMS has replaced the Progressive Corrective Action (PCA) ADR/Medical Review process with Targeted Probe & Educate (TPE). With this change comes a different approach to reviews and how Additional Development Requests (ADRs) are sent to agencies. Much of PCA is still present, but with some key changes, so TPE is not the same old process. Check out our comprehensive list of what TPE IS and what TPE IS NOT.
Completing the new Emergency Preparedness Plan (EP) for your home care agency is not an easy task and the time to finish is now. Caution should be used in preparation. Begin with QIRT's checklist.
A number of months ago, CMS released the Interpretive Guidelines on Emergency Preparedness for all providers. Many have not heeded the warning and we are now at the 11th hour. Your agency must have all plans in place and all drills completed by November 15, 2017. If you have not begun the process, you are not... Continue Reading →
QIRT is sponsoring a webinar series on The Home Health Groupings Model (HHGM) with Elevating HOME. Join us! November 2, 1 pm EST Coding in HHGM - PART I Playing a New Game by Getting Back to Basics The Home Health Groupings Model (HHGM) will go into effect January 2019, bringing with it some of... Continue Reading →
Targeted agencies receive 20-40 audits. Agencies with moderate to high error rates will continue on to the second round of 20-40 charts, and then a third.
Phase three of CMS’s probe and educate is underway. The first wave of letters is in the mail. Your agency will be in this first round if you failed to respond to previous ADR requests, if you had two or more denials, if you were offered education but did not participate, or if your agency... Continue Reading →
Prepare for CMS Probe and Educate's additional ADR requests this fall. Is your home care agency on the list?
Direct the change. Assign a transition leader, such as the administrator, a compliance officer, or a quality assurance manager, to be the change agent. Use the tools at hand. Talk to your EMR vendor right away to discover what is being done to aid compliance. Is quality assessment and performance improvement (QAPI) information being... Continue Reading →