I know that the mandatory ‘go live’ date isn’t until July 1st for claims to be in compliance with G-Codes and Severity Modifiers. However, why wait until the last minute? If you haven’t contacted you software vendor to discuss when
To Treat Or Not To Treat
It is not news to anyone that skilled nursing facilities, in particular therapy services, are under an enormous amount of scrutiny these days and are being inundated with CMS initiatives and regulations that often contradict one another. A few examples
What is Dementia?
Dementia is categorized as a progressive determination of cognitive skills and ability to adapt to activities of daily living, in the absence of other etiologies. It is of insidious onset and related impairments do not include delirium. It is often
Reasonable and Necessary Therapy Services
We have been hearing for years that therapy services must be reasonable and necessary. Now, with all Medicare Part B claims over $3,700 being reviewed by RACs, MACs conducting focused Probe audits, and don’t forget about the ZPIC audits, it is even more important that therapy
QAPI: Developing A Plan
A written QAPI plan guides the nursing home’s quality efforts and serves as the main document to support implementation of QAPI. The plan describes guiding principles that will be used in QAPI as well as the scope QAPI will have
IT’S FUNDAMENTAL
With a child in high school and another in middle school, I have for the better part of the last ten years, been fully immersed in sports from youth to high school age. The one thing that becomes more and
New Info on Manual Medical Review Process
CMS posted last night with final guidance on the Manual Medical Review for therapy claims above $3,700. Medicare Administrative Contractors (MACs) will conduct prepayment reviews until March 31, 2013 then beginning April 1, 2013 Recovery Audit Contractors (RACs) will conduct all reviews
NON-COMPLIANCE ALERTS – THERAPY FUNCTIONAL REPORTING
Functional Pathways wanted you to be aware that you might receive non-compliance alerts for outpatient therapy functional reporting G-Codes and severity modifiers from your MAC. These alerts do not apply to institutional claims. There will be no alert messaging for institutional
Mandatory Payment Reductions in FFS
In a CMS Medicare FFS Provider e-News bulletin released 3-8-13, the Medicare Learning Network issued the following information about the effect of sequestration on Medicare Fee-For-Service Programs: Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program – “Sequestration” The Budget
Outpatient Therapy Claims Crossover Problem
In the Thursday March 7, 2013 CMS FFS Provider e-News reports problems impacting crossover of Medicare Part B Outpatient Therapy Claims. CMS reports that providers who bill Medicare for outpatient therapy may have recently noticed an increase in the frequency of Health Insurance