Reimbursement Audits: Understanding the Trends & How to Prepare for Them. Andrea Stark, Consultant/Owner, miravista,llc, Columbia, SC
|
|
- Kristopher Neal Day
- 5 years ago
- Views:
Transcription
1 Reimbursement Audits: Understanding the Trends & How to Prepare for Them Andrea Stark, Consultant/Owner, miravista,llc, Columbia, SC
2 Top 4 Things to Know for CE 1. Make sure your BADGE IS SCANNED each time you enter a session to record your attendance. 2. Carry your Evaluation Packet with you to EVERY session. 3. Pharmacists, Pharmacy Technicians and Nurses need to track their hours on the Statement of Continuing Education Form as they go (the 2-page triplicate form, so press firmly!). 4. FOR CE: At your last session, total the hours and sign both pages of your Statement of Continuing Education Form. Keep the PINK copy for your records and place the YELLOW and WHITE copies in your CE Envelope. Make sure an Evaluation Form is in your CE Envelope for each session you attended (extra forms are available at the registration desk if you forgot to pick one up). Write your name and unique ID number (six digit number at the bottom of your name badge) in the designated area on the outside of the envelope, seal it, and place it in the drop box located near the 4/8/ registration area.
3 Andrea Stark is Consultant/Owner of miravista,llc. The conflict of interest was resolved by peer review of slide content. Clinical trials and off-label/investigational uses will not be discussed during this presentation. 4/8/2012 3
4 Agenda Audits Impacting Home Infusion Providers The OIG s Radar for 2012 RAC, CERT, ZPIC, DME MACS Top Reasons for Denial Lessons Learned Will Your Documentation Cut the Mustard? Take a Proactive Approach Educate Referral Sources 4
5 Agenda Understanding Your Rights Appealing an Unfavorable Determination Putting Together Your Response Audit Proofing Your Business Conducting Internal Audits Educational Resources for Staff 5
6 Audits Impacting Home Infusion Providers
7 On The OIG s Radar for 2012 Enteral/Parental High Billing Volumes Medicare Pricing for Parenteral Nutrition Too High Compared to Others? Use of Surety Bonds to Recover Overpayments Solicitation of Physicians Under Competitive Bidding 7
8 On The OIG s Radar for 2012 Compliance with Assignment Rules Claims with GA, GZ, GX and GY Modifiers Services Ordered by Excluded Physicians 8
9 Recovery Audit Contractors 3 Types of Reviews: Automated Complex New: Semi Automated 9
10 Automated Reviews Software Driven Process 100% Certainty of Error No Records Requested Unlimited Number Overpayment = Payment Demand Letter 10
11 Complex Reviews Human Review Not 100% Certain of Error Medical Records Requested = Additional Documentation Request Letter Limited Number Max of 10% of Annual Billing Volume per 45 days Capped at 250 Records, per 45 days May Request Permission to Exceed Cap 11
12 Complex Reviews Respond Within 45 Days of Date on ADR Letter RACs Have 60 Days to Respond Review Results Letter Will Include: RACs Decision Regulation Violated Information on Appeal Rights 12
13 Complex Reviews Overpayment Determination = Payment Demand Letter Infusion NOT Currently Under Complex Review 13
14 RAC Regulations Limited to a 3 year Look Back Period Always post payment reviews Issues must be approved by CMS Issues must be posted to website 14
15 On going RAC Reviews Name Description Jurisdictions Auditing Parenteral Nutrition Additives with Premix When premix parenteral nutrition solutions are used there may not be separate billing for the carbohydrates, amino acids or additives. A Infusion Supplies (A4221) Excessive Units Infusion supply code A4221 is billed on a weekly basis. Providers are billing A4221 more than one unit per week which resultsinanoverpayment. C PEN supplies more than 1 time a day The description or the billing guidelines state parenteral/enteral nutrition codes are allowed once a day. D Infusion Pump Denied/ Accessories & Drug Codes should be denied When the infusion pump is denied, then the infusion accessories and infusion drug codes are also denied. D 15
16 Name Pharmacy Supply Dispensing Fee On going RAC Reviews Description Medicare pays pharmacy supply/dispensing fees for immunosuppressive, oral anti cancer, chemotherapeutic, and oral anti emetic drugs as well as drugs used as part of an anti cancer chemotherapeutic regimen when they are submitted on the same claim as the drug being billed. A claim submitted with a pharmacy supply/dispensing fee in the absence of any of the previously mentioned drugs represents an overpayment and will be denied as not medically reasonable and necessary. Jurisdictions Auditing B 16
17 IVIG Rescinded IVIG Audit Human Immunoglobulin G Administered by intravenous infusion Contains antibodies 17
18 Claims Targeted: Rescinded IVIG Audit IVIG billed with chemotherapeutic administration codes Incorrect RAC Rational: IVIG infusion therapy should be billed with therapeutic administration codes, not chemotherapeutic Audit Rescinded July 5, 2011 Source: news/105 july
19 ZPICs Zone Program Integrity Contractors (ZPICs): Formerly Program SafeGuard Contractors (PSCs) Review Parts A D, Home Health and Medi Medi Analyze data, look for outliers Conduct pre pay and post pay audits Main Objective = Identify Fraud Payments suspended pending investigation 19
20 ZPICs Zone Program Integrity Contractors (ZPICS): Audits unannounced or limited notice Uses statistical sampling to estimate overpayments Payment demand letters come from your MAC Respond within 30 days of date on letter ZPICs no time limit No maximum records 20
21 ZPIC Zones Safegaurd Services LLC Zone 1 CA, NV, American Samoa, Guam, HI, and the Mariana Islands. Zone 7 FL, Puerto Rico and Virgin Islands AdvanceMed Corporation (Acquired by NCI, Inc.) Zone 2 AK, WA, OR, MT, ID, WY, UT, AZ, ND, SD, NB, KS, IA and MO Zone 5 AL, AK, GA, LA, MS, NC, SC, TN, VA and WV Health Integrity, LLC Zone 4 CO, NM, OK, and TX 21
22 ZPIC Zones TBD Currently Under Protest Zone 3 MN, WI, IL, IN, MI, OH, and KY TBD Currently Under Protest Zone 6 PA, NY, MD, Washington DC, DE, ME, MA, NJ, CT, RI, NH, and VT 22
23 CERT Comprehensive Error Rate Testing (CERT): Targets DME MACs more than suppliers Sample of suppliers audited Audits identify DME MAC overpayments Error rate identified High error rate = widespread DME MAC prepay reviews 23
24 CERT Comprehensive Error Rate Testing (CERT): Always request additional documentation The requests identify patient and records under review Requests NOT limited to LCD Documents from other CMS Manuals may be cited Respond within 75 Days of the date on the letter Respond via fax or mail 24
25 DME MACs Durable Medical Equipment Medicare Administrative Contractors (DME MACs): Process claims Medical Reviews (MRs) = Nurse reviewers manually process responses Medically Unlikely Edits (MUEs) = Automated Excess units of service, span dates, Etc. 25
26 DME MACs Jurisdictions Auditing for Enteral Nutrition: A NHIC Prepay: B9000, B9002 (Pumps) Previous quarter charge denial rate 73.9% C CIGNA Prepay: B4150, B4154 (Formula) Previous quarter charge denial rate 64% 26
27 Top Reasons for Denial Jurisdiction A, NHIC: Insufficient clinical documentation No medical records submitted No proof of delivery Missing patient name, date or signature Item provided not listed Missing detailed written order Incomplete Order dated after delivery 27
28 Top Reasons for Denial Jurisdiction A, NHIC: Incomplete or missing DIF HCPCS Code not on DIF Illegible Records & Patient Refusals Dates Signatures Medical records 28
29 Top Reasons for Denial Jurisdiction C, CGS: No documentation of a non functioning GI tract (anatomical impairment or a motility disorder) Severity of condition not documented for specialty formula Patient history, physical exam, lab results No evidence standard formula tried Condition not permanent (at least 3 months) No records dated within 1 year of DOS verifying continued use and need 29
30 Lessons Learned CGS, Jurisdiction C: Proof of delivery If shipped, DOS = shipping date In person, DOS = date delivered/picked up Nursing Home Patients Combined delivery OK, BUT Break down individual nutrients/supplies per patient Refill requests must be documented so that refill quantities are based on the individual s not facility s needs 30
31 CGS, Jurisdiction C: Lessons Learned Preliminary dispensing order OK for delivery Written, fax or verbal Transcribe verbal Detailed written order needed to bill Checklists do not equal medical records Do not alter DIF Form at all No company logo 31
32 Will Your Documentation Cut the Mustard?
33 Insufficient Documentation (Nutrition) Diagnosis codes ALONE Dispensing or prescription orders ALONE Supplier generated forms NOT a substitute for physician records! Stamped signatures Illegible signatures 33
34 Ensure You Have (Nutrition): Dispensing/verbal order Detailed written order Listing Each Item Billed Supplier signed and dated DIF (Form 10126) Clinical records supporting coverage criteria Permanent non function or disease of the structures that normally permit food to reach the small bowel, or Disease of the small bowel which impairs digestion and absorption of an oral diet. Justification for pump or special formulas Proof of delivery Contractors must be able to determine who, what and where. 34
35 Pumps (B900 B9002): For Pumps Physician must document conditions that justify need, such as: Gravity feeding is not satisfactory due to reflux and/or aspiration Severe diarrhea Dumping syndrome Administration rate less than 100 ml/hr Blood glucose fluctuations Circulatory overload 35
36 Pumps (B900 B9002): For Pumps If discontinued for two consecutive months and later resumed, a new initial DIF is required If nutrition is changed from syringe/gravity to a pump A new Initial DIF is required (for pump) A revised DIF is required (for nutrition) 36
37 For Specialty Nutrients Specialty Nutrients (B4149, B4153 B4157, B4161 and B4162): Covered for patients with specific diseases Requires additional documentation identifying the specific condition and need for the nutrient Auditors expect evidence of failure on standard formulas No more LCA = meet requirements or ABN 37
38 For Nutrients Revised DIF needed for ALL nutrients if: Number of calories per day changes Number of days per week the nutrient is administered changes Method of administration changes between syringe, gravity, or pump Route of administration changes from feeding tubes to oral tubes (if billing for a denial) 38
39 For E0799 Use JB modifier for subcutaneous immune globulin, and pump E0779 LCA Removed for E0781/E0791 for subcutaneous immunoglobulin (must bill E0779 only) 39
40 Refills and Supplies Patient must be contacted prior to delivery Contact no more than 14 days before expected depletion May deliver 10 days early (NOT routinely) Confirm supply is nearly depleted Obtain information on frequency of utilization Are you the only supplier? 40
41 Refills and Supplies For telephone contact, document: The patient s name The person contacted (patient or caregiver) General description of items requested Statement that refill is requested Date of contact 41
42 Refills and Supplies For written contact, document: The patient s name General description of items requested Statement that refill is requested Patient or caregiver s signature and date 42
43 Maintaining Documentation Documentation must be on file for 7 years Cut back on paper files Consider a scanning solution Maintain electronic copies Faster recall of old documents More organized Less storage space 43
44 Take a Proactive Approach Key in all patient information at intake Insurance information Address information ABNs Verify prescriptions/orders prior to delivery Get signed DIF on file Check for same or similar Already had a pump in the past 5 years? Real time eligibility checks for SNF or HH stays 44
45 Take a Proactive Approach Don t assume the system will catch all errors Make a diagnosis code & common HCPCs cheat sheet: Screen for every transmission! Use software to flag when diagnoses & HCPCs don t match Make a list of HCPCs to check for policy specific modifiers (BA, BO, KX, etc) 45
46 Take a Proactive Approach Obtain notes from all sources High calorie diets (exceeding 2000 calories) Physical therapy Oncologist notes Cal/kg requirements Dietitian Call 10 Days ahead to confirm refills needed Document patient response Protocol for date stamping documentation 46
47 Educating Referral Sources Audit physician records Are you comfortable? Long or short turn around time? Support medical necessity? Missing required pieces of information? 47
48 Educating Referral Sources Check your DME mac s website: Physician documentation request letters Enteral nutrition dear physician letter Include cover letters quoting LCD coverage requirements Not regulated, but be broad based Provide documentation checklist Although not considered part of medical record 48
49 Myth: Obtaining Documentation HIPPA prevents physicians from supplying requested documents Truth: HIPPA allows disclosure of PHI for: Treatment Payment Health care operations 49
50 Obtaining Documentation SSA mandates physicians comply with documentation requests Section 1842(p)(4): [i]n case of an item or service ordered by a physician or a practitioner but furnished by another entity, if the Secretary (or fiscal agent of the Secretary) requires the entity furnishing the item or service to provide diagnostic or other medical information in order for payment to be made to the entity, the physician or practitioner shall provide that information to the entity at the time that the item or service is ordered by the physician or practitioner. 50
51 Make it Easy to Send Ask up front, while fresh Include pre addressed, pre stamped envelope Accept faxes Electronic medical records are acceptable Get the patient involved 51
52 Understanding Your Rights
53 Your Rights You have every right to appeal a denial There is NO fee to appeal a denial at any level You do NOT need a lawyer to appeal Submitting an appeal does NOT increase your audit vulnerability Success increases at higher levels 53
54 Your Rights You can delay recoupments from post payment audits Collection attempts must stop when an appeal is filed at levels 1 or 2 Redeterminations (level 1): Contractors must wait 41 days to collect You have 120 days to appeal from the EOB date Reconsiderations (level 2): Contractors must wait 60 days to collect You have 180 days to appeal from the EOB date 54
55 Details Are Critical Pay attention to dates: Anywhere from days to respond Date = date response must be received Pay attention to requirements: Know the reason for denial Only submit what is requested Submit all documents at one time Follow submission guidelines to a T 55
56 Be Prepared to Submit The preliminary dispensing/verbal order Detailed written order Physician progress notes to verify medical necessity Signed DIFs Proof of delivery Requested medical records from: Physician s office, nursing home, HHA, hospital, lab, dietitian 56
57 Levels of Appeal Redetermination Reconsideration Administrative Law Judge Departmental Appeals Board Judicial Review 57
58 Levels of Appeal Redeterminations (1st level) 120 days from the date on the EOB Medicare has 60 days to respond Reconsiderations (2nd level) 180 days from the date on the EOB Qualified Independent Contractor (QIC) Medicare has 60 days to respond 58
59 Levels of Appeal Administrative Law Judge (ALJ) (3rd Level) Appeal within 60 days of Level 2 decision $130 minimum Video or telephone hearing (in person on a caseby case basis) Generally held within 90 days 59
60 Levels of Appeal Departmental appeals board (DAB) (4th level) Appeal within 60 days of Level 3 decision No minimum amount Appeals generally processed within 90 days File with local Social Security office or address in ALJ Decision Letter 60
61 Levels of Appeal Judicial Review/US District Court (5th Level) Appeal within 60 days of Level 4 Decision $1350 minimum Follow instructions in DAB Decision Letter 61
62 Putting Together Your Response Gather documents to support your claim Claim forms, EOBs, progress notes DIFs, delivery tickets, hospital records Physician evaluations, communication logs, etc. Keep copies for your records Verify receipt 62
63 Putting Together Your Response Be organized! Number all pages (X of Y) Include a summary paragraph (what and why?) Include a table of contents (where?) Underline relevant information Prescreen your documentation Is it relevant? 63
64 Audit Proofing Your Business
65 Conduct Internal Audits Query claims in batch mode monthly or quarterly Review patient files to catch errors internally Pull patients from specific product categories with various EOB dates Standardize the forms you use: Be consistent Use checks and balances Appoint a Compliance Officer Have work independently reviewed 65
66 Review: Review and Verify Client charts, billing records, EOBs Product coding, chart notes, LCDs Verify: Patient information Eligibility AOB Signatures and dates 66
67 Verify: Review and Verify Dispensing/verbal order Descriptions, alterations, signatures and dates Detailed written order Quantity, options/accessories, frequency of replacement, LON etc. Billing accuracy Modifiers, HCPCS, quantity, ICD 9 = match Medical documentation, DIF, ABN = on file 67
68 Verify: Review and Verify Delivery documentation Patient signatures and dates Who signed? Relationship on file Delivery service (FedEx ) DOS = date shipped Quantities, charges, descriptions = match SNF = identified for specific patient, records account for supply utilization 68
69 Educational Resources for Staff DME MAC Tools: Documentation checklists Capped rental calculator Enteral units of service calculator Redetermination request calculator Reconsideration request calculator Physician education letters Modifier finder tools and usage tables Appeals time limit calculators Timely filing calculators Supply refill and contact calculators DME FAQs Ask the Contractor teleconferences Free, product specific webinars 69
70 Educational Resources for Staff RSS Feeds E mail Feeds MiraVista News Blog HME News, Homecare Mag, HME Business AAHomecare Blog Sign up for List Serves NHIA Listserv CMS List Serves DME MAC List Serves Join LinkedIn Groups Durable Medical Equipment Group HME Industry Network Group Medicaid and Medicare Network Group Medical Billing and Coding Forum 70
71 Educational Resources for Staff This site will allow you to look up HCPCS product classifications, fee schedules and modifiers. Click on the DMECS tab (DME Coding System) Select Search for codes or fees Bookmark this site to your favorites: In many cases, a manufacturer s product has to be specifically approved by PDAC prior to being covered by Medicare 71
72 Educational Resources for Staff Join an Association NHIA tools and resources specific to the home infusion industry Your state association will help you fight local and national battles and give you access to Medicaid agencies and local payers to name a few benefits. Find your association here: American Association for Homecare Member Services Organizations Hold workshops and webinars Coordinate discounted purchasing Provide support to the business as a whole Offer contracting services to get you in network with more payers 72
73 Educational Resources for Staff DME Pricing Data Analysis and Coding (PDAC) CMS Quarterly HCPCS Updates Annual HCPS Updates Look for the 2012 Alpha Numeric HCPCS File. These are great resources that will allow you to maintain a current in house database that your staff may verify coding against 73
74 Educational Resources for Staff MLN Matters Articles (Search by Dates and Keywords): LCDs and Policy Articles Bookmark Your DME MACs LCD website (My favorite: Check for Revised LCDs: coverage database/ Select the Indexes tab and look for LCDs by contractor (i.e. NGS DME MAC) Here you can see Active, Future and Draft LCDs. To see all recently revised LCDs, sort by Last Updated. 74
75 Learning Assessment Questions & Answers Please refer to the NHIA Annual Conference & Exposition 2012 On Site Program for a brief post test. andrea@miravistallc.com x 240 4/8/
76 Disclaimer These materials and links to other sources are provided for informational purposes only and are not intended to be and should not be construed as legal advice. MiraVISTA does not guarantee or warrant that the materials are without error or present a complete explanation of all aspects of coverage or billing. Laws and procedures change frequently and are subject to differing interpretations. Content and information is subject to change without notice. 76
Reimbursement Audits: How to Prepare for Them. Andrea Stark, MiraVista LLC DMEPOS Consultant & Reimbursement Specialist
Reimbursement Audits: Understanding the Trends & How to Prepare for Them Andrea Stark, MiraVista LLC DMEPOS Consultant & Reimbursement Specialist Top 5 Things to Know for CE: Make sure your BADGE IS SCANNED
More informationAdvanced Nurse Practitioner Supervision Policy
Advanced Nurse Practitioner Supervision Policy Supervision requirements for nurse practitioners (NP) fall into two basic categories: Full practice and collaborative practice, which requires a Collaborative
More informationNational Perspective No Wrong Door System. Administration for Community Living Center for Medicare and Medicaid Veterans Health Administration
National Perspective No Wrong Door System Administration for Community Living Center for Medicare and Medicaid Veterans Health Administration Agenda National Perspective No Wrong Door System What is a
More informationClarifying Medicare Reimbursement Documentation Requirements: Everything Old is New Again
Clarifying Medicare Reimbursement Documentation Requirements: Everything Old is New Again Speaker(s) Deanne Birch, President, HICAP, Inc. Consulting Services, Park City, Utah Mike Semon, RPH, President,
More informationObjectives. The Alphabet Soup Of Hospice Scrutiny
Leadership And The Interdisciplinary Group: Overcoming Organizational Challenges In A Time of Change Alphabet Soup For The Hospice Soul: Understanding The Impact Of RHHI, MAC, RAC, CMS, OIG, FBI and DOJ
More informationToday s presentation
Centers for Medicare & Medicaid Services Update Healthcare Enforcement Compliance Institute October 31, 2017 Kim Brandt, J.D., M.A. Principal Deputy Administrator for Operations, Centers for Medicare &
More informationReport to Congressional Defense Committees
Report to Congressional Defense Committees The Department of Defense Comprehensive Autism Care Demonstration December 2016 Quarterly Report to Congress In Response to: Senate Report 114-255, page 205,
More informationMedicaid Innovation Accelerator Program (IAP)
Medicaid Innovation Accelerator Program (IAP) HCBS Conference IAP Session: Where We ve Been and Where We re Going September 2, 2015 Karen LLanos, David Shillcutt, & Michael Smith Center for Medicaid and
More informationPolicies for TANF Families Served Under the CCDF Child Care Subsidy Program
Policies for TANF Families Served Under the CCDF Child Care Subsidy Program Sarah Minton, Christin Durham, Erika Huber, Linda Giannarelli Presentation for NAWRS/NASTA 2012 Context Many TANF families receive
More informationCMNs Chapter 4. Chapter 4 Contents
Chapter 4 Contents 1. Certificates of Medical Necessity (CMNs) and DME MAC Information Forms (DIFs) 2. CMN and DIF Completion Instructions 3. CMNs as Orders and Claim Submission 4. Oxygen CMNs 5. CMN Common
More informationDME: DO YOU HAVE THE RIGHT DOCUMENTATION?
DME: DO YOU HAVE THE RIGHT DOCUMENTATION? RHONDA ZOLLARS, COC, CPC Copyright 2016 AAPC DISCLAIMER ALL MATERIAL IS PUBLIC ACCESSABLE ALWAYS VERIFY YOUR STATE LAWS, PAYOR POLICIES, CONTRACTS, OBJECTIVES
More informationPrescription Monitoring Programs - Legislative Trends and Model Law Revision
Prescription Drug Monitoring Programs Training and Technical Assistance Center Webinar Series National Alliance for Model State Drug Laws: Legislative Round-Up July 22, 2015 Prescription Monitoring Programs
More informationThe Value and Use of CME in Medical Licensure
2011 Federation of State Medical 2011 Boards Federation of State Medical Boards The Value and Use of CME in Medical Licensure ACCME Newcomers Workshop July 31, 2013 2011 Federation of State Medical Boards
More informationReimbursement for Blood Products and Related Services in 2017
Reimbursement for Blood Products and Related Services in 2017 Covance Market Access Services Inc. For the American Red Cross Biomedical Services National Headquarters 1 2017 Covance Market Access Services
More informationPractice Advancement Initiative (PAI) Using the ASHP PAI Ambulatory Care Self-Assessment Survey
Practice Advancement Initiative (PAI) Using the ASHP PAI Ambulatory Care Self-Assessment Survey Jodie Elder, PharmD, BCPS September 14, 2017 Objectives List the key components of the Practice Advancement
More informationDefensive Documentation for Long-Term Care
Defensive Documentation for Long-Term Care Strategies for creating a more lawsuit-proof resident record Tra Beicher RNC, ARM, HRM, CWS Contents About the author............................................
More informationOptions Counseling in and NWD/ADRC System National, State & Local Perspectives
Options Counseling in and NWD/ADRC System National, State & Local Perspectives Introductions Joseph Lugo, Administration on Community Living Sara Tribe, NASUAD Maurine Strickland, Wisconsin Barbara Diehl,
More informationMedicare & Medicaid EHR Incentive Programs Robert Tagalicod, Robert Anthony, and Jessica Kahn HIT Policy Committee January 10, 2012
Medicare & Medicaid EHR Incentive Programs Robert Tagalicod, Robert Anthony, and Jessica Kahn HIT Policy Committee January 10, 2012 Medica re Active Registrations December 2011 December-11 YTD Eligible
More informationSubcontracting Tools. First Wednesday Virtual Learning Series 2018
Subcontracting Tools First Wednesday Virtual Learning Series 2018 Hosts Christopher Eischen, Procurement Center Representative SBA Office of Government Contracting, Area IV, Kansas City, MO Deborah Crumity,
More informationGovernor s Office of Electronic Health Information (GOEHI) The National Council for Community Behavioral Healthcare
Governor s Office of Electronic Health Information (GOEHI) The National Council for Community Behavioral Healthcare PBHCI Grantees by HHS Regions AK (2) OR WA (3) Region 10 6 Grantees ID MT Region 8 2
More informationRole of State Legislators
Title text here NCSL Fall Forum Preconference Session: Quality & Consumer Issues in Medicaid Managed LTSS December 3, 2013 Wendy Fox-Grage Senior Strategic Policy Advisor AARP Public Policy Institute Role
More informationSummary of 2010 National Radon Action Month Results
Summary of 2010 National Radon Action Month Results This document summarizes the results of the 2010 National Radon Action Month. The summary describes the total number of 2010 activities compared to 2009
More informationSummary of 2011 National Radon Action Month Results
Summary of 2011 National Radon Action Month Results This document summarizes the results of the 2011 National Radon Action Month (NRAM). The summary describes the total number of 2011 activities compared
More informationDirector, Army JROTC Program Overview
U.S. Army Cadet Command Director, Army JROTC Program Overview Motivating young people to be better citizens 1 U.S. Army Cadet Command Motivating Young People to be Better Citizens Acronyms AI Army Instructor
More informationUpgrading Voter Registration in Florida
Upgrading Voter Registration in Florida David Becker Director, Election Initiatives 1 2012: Florida Snapshot Below National Average of 71.2% 2 Change in Voting Age Population (VAP), 2008-2012 U.S. Census
More informationNCHIP and NICS Act Grants Overview and Current Status
BUREAU OF JUSTICE STATISTICS NCHIP and NICS Act Grants Overview and Current Status Devon B. Adams Criminal Justice Data Improvement Program SEARCH Membership Group Meeting Nashville, TN - February, 2010
More informationPatient-Centered Specialty Practice Readiness Assessment
Patient-Centered Specialty Practice Readiness Assessment Daryn Eikner Vice President, Health Care Delivery National Family Planning & Reproductive Health Association Melissa Kleder Manager, Health Care
More informationNew Medical Review Strategy: Targeted Probe and Educate 1928_0917
New Medical Review Strategy: Targeted Probe and Educate 2017 1928_0917 Today s Presenters J6 and JK Provider Outreach & Education Consultants Jean Roberts, RN, BSN, CPC Nathan L. Kennedy, Jr., CHC, CPC,
More informationUnited States Property & Fiscal Officer (USPFO)
United States Property & Fiscal Officer (USPFO) NGAUS 2017 Industry Partner Workshop 7 September 2017 This briefing is UNCLASSIFIED Doing business with The 54 What is a United States Property and Fiscal
More informationPrescription Monitoring Program:
Massachusetts Department of Public Health Prescription Monitoring Program: The Massachusetts Prescription Monitoring Tool (MassPAT) November 1, 2016 Goals of the Session Understand the mission and responsibilities
More informationBUFFALO S SHIPPING POST Serving Napa Valley Since 1992
BUFFALO S SHIPPING POST Serving Napa Valley Since 1992 2471 Solano Ave Napa, CA 94558 707-226-7942 FAX: 707-226-1510 buffship.com October 21, 2017 RE: New Pricing Hi Everyone, Because of continual fuel
More informationMEMORANDUM Texas Department of Human Services * Long Term Care/Policy
MEMORANDUM Texas Department of Human Services * Long Term Care/Policy TO: FROM: LTC-R Regional Directors Section/Unit Managers Marc Gold Section Manager Long Term Care Policy State Office MC: W-519 SUBJECT:
More informationRebates & Incentives - WTF. Lee Guthman February 28, 2012
Rebates & Incentives - WTF Lee Guthman February 28, 2012 1 The dilemma we face 2 Who is GreenOhm? Mainstream benefits of energy efficient products and services Drive purchasing behavior for energy efficient
More informationACRP AMBASSADOR PROGRAM GUIDELINES
ACRP AMBASSADOR PROGRAM GUIDELINES The Airport Cooperative Research Program (ACRP) is an industry-driven, applied research program that develops near-term, practical solutions to problems faced by airport
More informationHome Health Agency (HHA) Medicare Margins: 2007 to 2011 Issue Brief July 7, 2009
Home Health Agency (HHA) Medicare Margins: 2007 to 2011 Issue Brief July 7, 2009 Dobson DaVanzo & Associates, LLC (www.dobsondavanzo.com) was commissioned by the LHC Group to conduct a margin study for
More informationTopics. Overview of the Medicare Recovery Audit Contractor (RAC) Understanding Medicaid Integrity Contractor
RACS, ZPICS & MICS John Falcetano, CHC-F, CCEP-F, CHPC, CHRC, CIA Chief Audit and Compliance Officer University Health Systems of Eastern Carolina jfalceta@uhseast.com Topics Overview of the Medicare Recovery
More information4/20/2015. NE Home Care & Hospice Conference: Strategic Preparation for Medicare Audits & Appeals. Today s Objectives. Background
NE Home Care & Hospice Conference: Strategic Preparation for Medicare Audits & Appeals Cheryl Leslie, RN, MPH Director of Consulting Services Pamela Meliso, JD, MPH Director of Consulting Services Today
More informationNational Provider Identifier (NPI)
National Provider Identifier (NPI) Importance to the Athletic Training Profession? By Clark E. Simpson, MBA, MED, LAT, ATC National Manager, Strategic Business Development National Athletic Trainers Association
More informationNational Committee for Quality Assurance
National Committee for Quality Assurance (NCQA) Private, independent non-profit health care quality oversight organization founded in 1990 MISSION To improve the quality of health care. VISION To transform
More informationASA Survey Results for Commercial Fees Paid for Anesthesia Services payment and practice manaement
payment and practice manaement ASA Survey Results for Commercial Fees Paid for Anesthesia Services 2015 Stanley W. Stead, M.D., M.B.A. Sharon K. Merrick, M.S., CCS-P ASA is pleased to present the annual
More informationRecovery Audit Contractors: AHA Perspective. Elizabeth Baskett, Policy, AHA February 23, 2012
Recovery Audit Contractors: AHA Perspective Elizabeth Baskett, Policy, AHA February 23, 2012 Agenda Lay of the Land = Audit Overload RACs (Medicare & Medicaid) MACs ZPICs and OIG and DOJ, oh my! AHA and
More informationNational Association For Regulatory Administration
National Association For Regulatory Administration Annual NARA Licensing Seminar Presenters: Alfred C. Johnson Patricia Adams Agenda Introductions Incident Reports -- Assisted Living Alfred Johnson, Director,
More informationBuilding Blocks to Health Workforce Planning: Data Collection and Analysis
Building Blocks to Health Workforce Planning: Data Collection and Analysis Presented by: Jean Moore, DRPH Director October 22, 2015 Center for Health Workforce Studies School of Public Health University
More informationASA Survey Results for Commercial Fees Paid for Anesthesia Services practice management
practice management ASA Survey Results for Commercial Fees Paid for Anesthesia Services 2013 Stanley W. Stead, M.D., M.B.A Sharon K. Merrick, M.S., CCS-P Thomas R. Miller, Ph.D., M.B.A. ASA is pleased
More information2012 Federation of State Medical Boards
Maintenance of Licensure: An Overview and Update Humayun Chaudhry, DO, MS, MACP, FACOI President and CEO, Federation of State Medical Boards Osteopathic International Alliance Annual Meeting Austin, Texas
More informationThe Affordable Care Act and Its Potential to Reduce Health Disparities Cara V. James, Ph.D.
The Affordable Care Act and Its Potential to Reduce Health Disparities Cara V. James, Ph.D. Director, Office of Minority Health Centers for Medicare & Medicaid Services April 22, 2013 The Affordable Care
More informationThe Journey to Meaningful Use: Where we were, where we are, and where we may be going
The Journey to Meaningful Use: Where we were, where we are, and where we may be going June 27, 2013 Matthew Stanford, WHA Louis Wenzlow, RWHC 1 Where have we been? When HIT Adop on Meaningful Use Adoption
More informationDiversifying AAA/ADRCs Funding Streams: How states and their local partners can draw down federal Medicaid Administrative Match for ADRC/NWD Systems
Diversifying AAA/ADRCs Funding Streams: How states and their local partners can draw down federal Medicaid Administrative Match for ADRC/NWD Systems July 30, 2017 n4a Conference Agenda What is the value
More informationAlaska (AK) Arizona (AZ) Arkansas (AR) California-RN (CA-RN) Colorado (CO)
Beth Radtke 49 Included in the report: 7/22/2015 11:17:54 AM Alaska (AK) Arizona (AZ) Arkansas (AR) California-RN (CA-RN) Colorado (CO) Connecticut (CT) Delaware (DE) District Columbia (DC) Florida (FL)
More informationThe Use of NHSN in HAI Surveillance and Prevention
The Use of NHSN in HAI Surveillance and Prevention Catherine A. Rebmann Division of Healthcare Quality Promotion (DHQP) Centers for Disease Control and Prevention (CDC) January 12, 2010 Objectives What
More informationNSF Award Cash Management $ervice (ACM$) and Financial Update. June 1, 2015
NSF Award Cash Management $ervice (ACM$) and Financial Update June 1, 2015 1 Agenda NSF s Transition to itrak Oracle Financials DFM Monitoring Activities NSF Grant Accrual Validation Improper Payments
More informationAward Cash Management $ervice (ACM$) National Science Foundation Regional Grants Conference. June 23 24, 2014
Award Cash Management $ervice (ACM$) National Science Foundation Regional Grants Conference June 23 24, 2014 1 Agenda Introduction of ACM$ itrak Conversion Processes Canceling Funds SAM Registration Program
More informationNE Home Care Conference: Effective & Efficient Preparation for Medicare Audits & Appeals
NE Home Care Conference: Effective & Efficient Preparation for Medicare Audits & Appeals Cheryl Leslie, RN, MPH Director of Home Care & Hospice Services Pamela Meliso, JD, MPH Director of Consulting &
More informationResearch Compliance Oversight in the Department of Veterans Affairs
Research Compliance Oversight in the Department of Veterans Affairs Karen M. Smith, PhD Director, Midwestern Regional Office Office of Research Oversight Department of Veterans Affairs Health Care Compliance
More informationSETTLEMENT ADMINISTRATION STATUS REPORT NO. 2
Case 2:05-md-01657-EEF-DEK Document 64857 Filed 03/19/14 Page 1 of 18 SETTLEMENT ADMINISTRATION STATUS REPORT NO. 2 MARCH 19, 2014 BROWNGREER PLC 250 Rocketts Way Richmond, VA 23231 www.browngreer.com
More informationRECOUNT RULES & VOTING SYSTEMS
state s be ed nces is permitted Voter ID Required Voting Systems Manufacturer AL Not more than 1/2 of 1% No provisions for. Non-photo ID AK Tie Vote Losing cand. or 10 voters may. Non-photo ID DRE with
More informationDevelopmental screening, referral and linkage to services: Lessons from ABCD
Developmental screening, referral and linkage to services: Lessons from ABCD J I L L R O S E N T H A L S E N I O R P R O G R A M D I R E C T O R N A T I O N A L A C A D E M Y F O R S T A T E H E A L T
More informationJurisdiction D DME MAC Provider Outreach and Education
Jurisdiction D DME MAC Provider Outreach and Education Advance Beneficiary Notice of Noncoverage Presented by Jurisdiction D DME MAC Outreach and Education Department February 2009 Agenda Definition and
More informationNCQA s Patient-Centered Medical Home Recognition and Beyond. Tricia Marine Barrett, VP Product Development
NCQA s Patient-Centered Medical Home Recognition and Beyond Tricia Marine Barrett, VP Product Development National Committee for Quality Assurance (NCQA) Private, independent non-profit health care quality
More informationJurisdiction C Council
RESPIRATORY 1. The Medicare RAD policy has defined Central sleep apnea (CSA) as: An apnea-hypopnea index (AHI) greater than 5, and Central apneas/hypopneas greater than 50% of the total apneas/hypopneas,
More informationCesarean Delivery Model Meeting the challenge to reduce rates of Cesarean delivery
Cesarean Delivery Model Meeting the challenge to reduce rates of Cesarean delivery Alan Mills FSA MAAA ND November 13, 2014 Agenda 1. Background 2. The U.S. Cesarean delivery challenge 3. Cesarean Delivery
More informationMedicaid Innovation Accelerator Project
Medicaid Innovation Accelerator Project 2016-2017 Technical Expert Panel In-Person Meeting Community Integration Community-Based Long-Term Services and Supports Breakout Session April 18-19, 2017 Community
More informationThe Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals 8/13/2018 OBJECTIVES
The Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals Becky Finni, DHS, OTR/L Kim Karr, BS, OTR/L Senior Appeal Specialists for RehabCare OBJECTIVES Understand
More informationComprehensive Care for Joint Replacement (CJR) Readiness Kit
Comprehensive Care for Joint Replacement (CJR) Readiness Kit Contents CMS Announces Shift From Volume To Value...2 Top Things To Know About CJR Final Rule...3 Proposed Timeline For CJR...4 Who Is Impacted?...5
More informationCACS, MACS & RACS WHAT TO EXPECT IN 2009
. CACS, MACS & RACS WHAT TO EXPECT IN 2009 Presented to GASCO University December 3, 2008 1 Presented by: Karen Beard Director Georgia Society of Clinical Oncology 2 Medicare Carrier Advisory Committee
More informationPresented at The Northeast Center to Advance Food Safety (NECAFS) Annual Meeting January 10, 2017 Boston, MA
State and Territory Cooperative Agreement to Enhance Produce Safety in Preparation of Implementation of FDA's Rule: Standards for the Growing, Harvesting, Packing, & Holding of Produce for Human Consumption
More informationDriving Change with the Health Care Spending Benchmark
Driving Change with the Health Care Spending Benchmark Delaware s Road to Value Kara Odom Walker, MD, MPH, MSHS Cabinet Secretary LIFE Conference, January 24, 2018 1 Join us on Twitter: @Delaware_DHSS
More informationMedicare and Medicaid Audit Defense & Appeals: From RACs to ZPICs September 7, 2012 Skokie, IL
Midwest Home Health Summit Best Practices Conference Series Medicare and Medicaid Audit Defense & Appeals: From RACs to ZPICs September 7, 2012 Skokie, IL Michael T. Walsh Principal Kitch Attorneys & Counselors
More informationBEST PRACTICES IN LIFESPAN RESPITE SYSTEMS: LESSONS LEARNED & FUTURE DIRECTIONS
BEST PRACTICES IN LIFESPAN RESPITE SYSTEMS: LESSONS LEARNED & FUTURE DIRECTIONS September 12, 2012 PRESENTERS: Greg Link, MA Program Officer Administration for Community Living U.S. Administration on Aging
More informationRoadmap. AAH Best Practices and Mobility Documentation. Policy History. History Continued. History Understanding Documentation
Roadmap AAH Best Practices and Mobility Documentation May 2008 History Understanding Documentation MAE NCD Key Concepts Audits The WHY of MR CMS Requirements 1 2 Policy History Original National Policy
More informationAdvancing Self-Direction for People with Head Injuries
Vermont Department of Disabilities, Aging and Independent Living Advancing Self-Direction for People with Head Injuries NASHIA SOS Conference Des Moines, IA September 27, 2018 Sara Lane Vermont Department
More informationNCCP. National Continued Competency Program Overview
NCCP National Continued Competency Program Overview State Recertification Model Use CA OR WA NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN KY WV PA VA NY NH VT NJ DE MD ME RI CT MA AZ NM OK AR
More informationMedicare Consolidate Billing & Overview
Medicare Consolidate Billing & Overview Julie Kearney, Kearney & Associates Consolidated Billing The Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to
More informationCenter for Clinical Standards and Quality /Survey & Certification
TO DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 Center for Clinical Standards and Quality /Survey
More informationSEASON FINAL REGISTRATION REPORTS
Materials Included: 2012-2013 SEASON FINAL REGISTRATION REPORTS 2011-12 & 2012-13 Comparison by Group 2 2012-13 USA Hockey Member Counts 3 2012-13 Non-Participant Membership Information 4 2012-13 8 and
More informationUsing SNF Data to Manage Federal & State Audit Initiatives
Using SNF Data to Manage Federal & State Audit Initiatives 2012 OIG & GAO Reports In 2009 OIG estimated that 47% of claims had misreported information on the MDS that caused significant errors in Billing
More informationZone Program Integrity Program & Recovery Audit Contractors
Zone Program Integrity Program & Recovery Audit Contractors Advance Planning and Responsive Tools. AHLA Long Term Care and the Law Program Feb 26, 2013 Presented by: Brain Daucher Esq. Sheppard Mullin
More informationNATIONAL GUARD BUREAU OFFICE OF SMALL BUSINESS PROGRAMS. Panelist: Dr. Donna Peebles Associate Director
The National Guard Association of the United States 18 th Annual Industry Day NATIONAL GUARD BUREAU OFFICE OF SMALL BUSINESS PROGRAMS http://www.nationalguard.mil http://www.sellingtoarmy.info Panelist:
More informationMedicaid Managed Care 2012 Fiscal Analysts Seminar August 30, 2012
Medicaid Managed Care 2012 Fiscal Analysts Seminar August 30, 2012 National Conference of State Legislatures Neva Kaye Managing Director for Health System Performance National Academy for State Health
More informationThe Next Wave in Balancing Long- Term Care Services and Supports:
The Next Wave in Balancing Long- Term Care Services and Supports: Top Trends Agency restructuring is common States use of variety of resources to fund the programs Loss of historical knowledge is nationwide
More informationOFFICE OF THE UNDER SECRET ARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, DC
OFFICE OF THE UNDER SECRET ARY OF DEFENSE 4000 DEFENSE PENTAGON WASHINGTON, DC 20301-4000 PERSONNEL AND READINESS The Honorable James M. Inhofe Chairman Committee on Armed Services United States Senate
More informationRAC Audits and Denials Management WHCA Fall Conference September 9, 2014
JoLynn Munro, MS,OTR/L, Regional Vice President Infinity Rehab Carolyn Staples, CCC/SLP, Area Rehab Director Infinity Rehab RAC Audits and Denials Management WHCA Fall Conference September 9, 2014 Objectives
More informationDEFINING LINES OF COMPLIANCE. April 2004 By: Angela Miller Compliance Officer Home Care Supply
DEFINING LINES OF COMPLIANCE April By: Angela Miller Compliance Officer Home Care Supply OUTLINE Broad brush on Audit Responses Finer Policy Points Education: The Vicious Circle A Private Showing: Attorney
More informationSafe Staffing- Safe Work
Safe Staffing- Safe Work PROFESSIONAL ISSUES CONFERENCE JUNE 2, 2017 SARA MARKLE-ELDER, ALICE BARDEN, RN AFT Nurses and Health Professionals is accredited as a provider of continuing nursing education
More informationFIELD BY FIELD INSTRUCTIONS
TRANSPORTATION EMEDNY 000201 CLAIM FORM INSTRUCTIONS The following guide gives instructions for proper claim form completion when submitting claims for Transportation Services using the emedny 000201 claim
More informationNEWS RELEASE. Air Force JROTC Distinguished Unit Award. MAXWELL AIR FORCE BASE, Ala. Unit OK at Union High School, Tulsa OK, has been
Union High School 6616 S. Mingo Rd Tulsa OK 74133 NEWS RELEASE Air Force JROTC 2010-2011 Distinguished Unit Award MAXWELL AIR FORCE BASE, Ala. Unit OK-20012 at Union High School, Tulsa OK, has been selected
More informationCrisis Management: One Size Does Not Fit All. Todd Jenkins Sr. Loss Prevention Security Specialist Cracker Barrel Old Country Store, Inc.
Crisis Management: One Size Does Not Fit All Todd Jenkins Sr. Loss Prevention Security Specialist Cracker Barrel Old Country Store, Inc. Cracker Barrel Introduction Company Overview 70k + employees 600
More informationValue based care: A system overhaul
Value based care: A system overhaul Lee A. Fleisher, M.D. Robert D. Dripps Professor and Chair of Anesthesiology Perelman School of Medicine at the University of Pennsylvania Email: lee.fleisher@uphs.upenn.edu
More informationHigher Education Employment Report
Higher Education Employment Report First Quarter 2017 / Published September 2017 Executive Summary The number of jobs in higher education increased 0.6 percent, or 22,100 jobs, during the first quarter
More informationCare Provider Demographic Information Update
Care Provider Demographic Information Update Please use this form for a single care provider practitioner update. Incomplete forms will not be processed. Fields with an asterisk (*) are required for practitioners
More informationRequest for Letters of Intent to Apply for 2017 Technology Initiative Grant Funding
This document is scheduled to be published in the Federal Register on 02/03/2017 and available online at https://federalregister.gov/d/2017-02249, and on FDsys.gov 7050-01 LEGAL SERVICES CORPORATION Request
More informationPatient Centered Medical Home Foundation for Accountable Care
Patient Centered Medical Home Foundation for Accountable Care Outline of Presentation History and tenants of the patient-centered care and PCMH model Defining, measuring, recognizing, and evaluating the
More informationAssuring Better Child Health and Development Initiative (ABCD)
Assuring Better Child Health and Development Initiative (ABCD) Presented by Jennifer May National Academy for State Health Policy Act Early Region X Summit Feb 4-5, 2010 Seattle, Washingon Supported by
More informationSmall Business and the Defense Industrial Base
DoD Office of Small and Disadvantaged Business Utilization The Front Line of Innovation Small Business and the Defense Industrial Base Frank Ramos, Director Department of Defense Office of Small and Disadvantaged
More informationEpisode Payment Models:
Episode Payment Models: Cardiac Bundle Initiative HFMA Florida Chapter (North Florida) October 25, 2016 Robert Howey MBA, MHA, CPA Revenue Cycle Manager 2016 MFMER slide-1 Objective After the session,
More informationASA Survey Results for Commercial Fees Paid for Anesthesia Services payment and practice management
payment and practice management ASA Survey Results for Commercial Fees Paid for Anesthesia Services 2016 Stanley W. Stead, M.D., M.B.A Sharon K. Merrick, M.S., CCS-P ASA is pleased to present the annual
More informationHospices Under the Microscope: Are You Prepared for ZPICs? Medicare Integrity Programs. Objectives. Fraud or Abuse? 3/3/2014
Hospices Under the Microscope: Are You Prepared for ZPICs? Paula G. Sanders, Esquire Principal & Chair Health Care Practice Post & Schell, PC Diane Baldi, RN CHPN Chief Executive Officer Hospice of the
More informationNursing Facilities, Staffing, Residents and Facility Deficiencies, 2001 Through 2007
Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2001 Through 2007 by Charlene Harrington, Ph.D. Helen Carrillo, M.S. Brandee Woleslagle Blank, M.A. Department of Social and Behavioral
More informationThe CMS Survey Guide Jeffrey T. Coleman
The CMS Survey Guide Jeffrey Jeffrey T. T. Coleman Coleman Contents About the Author......................................................... v Introduction............................................................
More informationMr. Bradley D. Taylor, Assistant Director SECNAV http://smallbusiness.navy.mil Report Documentation Page Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated
More information