Home Health|Hospice Articles and Resources
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PDGM Calculator for Home Health: Reminder, CMS has changed the unit of the home health payment from a 60-day episode to a 30-day period. When using the calculator, be sure that you enter the “Number of Visits” based on 30 days instead of 60 days. Read the entire article.
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Home Health (HH) Patient-Driven Groupings Model (PDGM)
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April 29th, 2021
58% of Improper Payments due to Medical Necessity for Ventilators
Published April 29th, 2021|
Proper documentation not only protects the provider, the payer, and the patient, it protects the integrity of the entire healthcare system. When it comes to coverage and documentation for durable medical, the DMEPOS supplier and staff must be familiar with the National and Local Coverage Determinations (NCDs and LCDs) as these are ...
October 28th, 2020
Published October 28th, 2020|
Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ...
October 1st, 2020
New Codes for Cytokine Release Syndrome (CRS)
Published October 1st, 2020 - Last Review/Update October 6th, 2020|
New codes for Cytokine Release Syndrome (CRS) are effective October 1, 2020 based on the grade/severity of the symptoms. This article covers the new grading scales.
August 28th, 2020
New Value-Based Payment Models for Primary Care (Primary Care First and Direct Contracting)
Published August 28th, 2020|
This article summarizes the new Medicare value-based payment models: Primary Care First and Direct Contracting.
August 10th, 2020
Modifier 50 — Four "Must Know" Tips For Getting Paid
Published August 10th, 2020|
Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...
July 20th, 2020
New Grouper Added for Skilled Nursing
Published July 20th, 2020|
The additional grouper for Skilled Nursing, sometimes referred to as (PDPM), is used for classifying SNF patients in a covered Part A stay. This grouper is included with our Home Health Grouper. Current groupers/calculators include: Home Health PDGM (Patient-Driven Grouping Model) Skilled Nursing Facility PDPM (Patient-Driven Payment Model) What is it? According to CMS, In ...
July 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
Published July 14th, 2020|
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
April 15th, 2020
New CPT® Codes Approved for COVID-19 Antibody Identification
Published April 15th, 2020|
On April 10, 2020, the American Medical Association approved and published a revision of code 86318 and added two new codes 86328 and 86769 for reporting Coronavirus [COVID-19] antibody testing.
March 31st, 2020
CMS-Coverage for Therapeutic Shoes for Individuals with Diabetes
Published March 31st, 2020|
Therapeutic shoes and inserts can play a vital role in a diabetic patient's health. Medicare may cover one pair every year and three pairs of custom inserts each calendar year if the patient qualifies and everything is handled correctly. Medicare Benefit Policy Manual explains what is needed for a person with diabetes to ...
March 5th, 2020
Who Qualifies for Chronic Care Management Services
Published March 5th, 2020|
Per MLN Chronic Care Management Services, the following patients are eligible: "Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services." Examples of chronic conditions ...
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