Focused Medical Review & ADR's
Why will you be probed electronically during the next 18 months?
Who really owns NGS, CAHABA, and Palmetto and why they are under new scrutiny from CMS?
Data triggers, Documentation deficiencies
Probe edit process
Focused medical review processes
Referral to the Benefit integrity group by the medical review teams
Medicare home health has changed in many ways, OASIS-C, Face to Face, and therapy thresholds have kept all of us so busy with minutia we have forgotten the most important relationship of all: the one we share with our RHHI. State and accreditation surveyors can force you to write plans of correction and reorganize. Within 5 minutes your billing can be audited by 50% on pre-pay basis. Within 5 minutes it can be turned off. Which one deserves the greatest attention?
Agencies accross the country pass accreditation surveys and department of health surveys everyday just to loose hundreds of thousands of dollars in medical review. RAD readiness seminars have supposedly protected agencies but no one has presented the inside story as of yet and how to audit using the same tools the RHHI and BI groups use. Now is the time to be informed as preparations thus far seem not to have provided the protection expected.