November 2018 Industry News

Nearly 1/3 of All Claims Fail Palmetto’s Targeted Probe & Educate (TPE) Review

CGS released results that within the first 6 months of TPE, its reviewers found that only 20% of HHAs that had completed round 1 of TPE were found “compliant”. A total of 1,671 claims have been denied so far. The top denial reasons (so far) were:

  • No plan of care or certification
  • No physician order for services or more than ordered
  • Face-to-Face encounter requirements not met
  • No documentation of services rendered

Be Prepared! Review our Case Management Services and take advantage of a complimentary audit today!

Ready for CMS’ New Review Choice Demonstration?

Pre-Claim Review has been revised and will now be referred to as the “Review Choice Demonstration” – set to begin on October 1, 2018.

The proposed changes are as follows:

  • 100% Pre-Claim Review
  • 100% Post Payment Review
    • Providers that choose one or the other will continue to be subject to a review method until the agency reaches the target affirmation or claim approval rate of 90%. Once it reaches the approval rating, it can choose to be relieved from the claim reviews (except for a spot check of 5%).
  • You can opt out of pre- and post-claim and accept a 25% payment reduction for all home health services and the possibility of a Recovery Audit Contractor (RAC) review.

Read the full proposal here.

HealthCare Synergy offers both TPE and RCD services! Take a look and let us help you!

Mileage Tax Deduction Changes

On May 25, the IRS made changes in December’s Tax Cuts and Jobs Act. Simply stated, if employees are not reimbursed for business mileage-related expenses, they can not deduct those expenses from their taxable net income. If the agency pays less than the standard rate, the recipient can’t deduct the difference between the rate paid and the standard rate on their individual income tax return as an itemized deduction.

For more information, see the IRS News Release here.

Get assistance with managing your agency’s bookkeeping by reviewing our Financial Management Services today!

OASIS-D Education Preparation

OASIS-D will be released on January 1, 2019. Final guidelines are set to be released in November of this year. It is expected that due to extra questions, OASIS-D will take longer to fill out than OASIS-C2. Here are a few of the changes so far:

  • GG0130-Self Car, GG0170-Mobility, J1800-Falls since SOC/ROC, and J1900-Number of Falls
  • M1311 has been standardized and will be used to measure Changes in Skin Integrity: Pressure Ulcer/Injury
  • M1313 will be Removed
  • GG0100-Prior Functioning and GG0110-Prior Device Use will be added to standardize data collected across post-acute-care settings.

For more information, see here.

We have OASIS Review, ICD Coding, & 485 Preparation Services to help you make sure you’re following all CMS’ guidelines.