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Compliance Adaptability

July 2, 2014 0 Comments
Compliance Adaptability

OIG Tips Series ~ Compliance adaptability is one of the tips given by Inspector General Dan Levinson by Inspector General Dan Levinson at HCCA’s Compliance Institute this past spring.  In continuing his use of colorful slides from the San Diego area the urban crow was front and center.  According to Levinson: ….the urban crow is a great adaptive creature. It actually will figure […]

OIG Compliance Tips

July 1, 2014 0 Comments
OIG Compliance Tips

OIG Tips Series ~ Do you have an off the shelf, or out of the box compliance plan?  OIG compliance tips given by Inspector General Dan Levinson at the annual HCCA Compliance Institute are always valued by the compliance officers and professionals in attendance at the keynote speech.  This spring at the Compliance Institute in San […]

Strategic Health Solutions Reports CMS Therapy Audit Results

May 13, 2014 4 Comments
Strategic Health Solutions Reports CMS Therapy Audit Results

Strategic Health Solutions just posted CMS Therapy Audit Results of one of their outpatient therapy audits.  Strategic conducted two audits involving outpatient therapy last summer.  The first audit topic was related to therapy stoppage at the end of the year 2012  (or at the cap), and then resumed in the new year (2013).  The second […]

Therapy Cap Reprieve April 1, 2014

April 1, 2014 2 Comments
Therapy Cap Reprieve April 1, 2014

There has been a therapy cap reprieve on this the fast day of April, 2014:  April Fools Day.  The “Stop the Therapy Caps” campaign was ultimately not successful, and one could argue that the only success out of the late breaking House and Senate Bills over the past week has been that we are in […]

Functional Limitation Reporting: More Claims Problems

March 19, 2014 4 Comments
Functional Limitation Reporting: More Claims Problems

Functional limitation reporting: more claims problems are being officially reported today – Wednesday, March 19, 2014.   When will it stop? The better question is when will it be resolved?  In a recent post  on functional limitation reporting, I discussed problems that were reported in the common working file that are scheduled to be corrected on Monday, March […]

Tricare and Private Practice PTAs

March 18, 2014 14 Comments
Tricare and Private Practice PTAs

Tricare policy does not allow for therapy to be paid when it is provided by a physical therapist assistant (PTA) in private practice settings.  A previous post on this generated a lot of comments , as well as a lot of email.  The reference in that post on Tricare and private practice PTAs was the […]

Medicaid Exclusion Checks

March 17, 2014 2 Comments
Medicaid Exclusion Checks

CMS issued a State Medicaid Director Letter (SMDL)  in 2009 recommending that States require providers to screen all employees and contractors monthly.  However in 2011, CMS issued final regulations mandating States to screen all enrolled providers monthly.   Furthermore Section 6501 of PPACA requires States to terminate individuals or entities from their Medicaid programs if the individuals […]

Importance of Checking Exclusions

March 16, 2014 2 Comments
Importance of Checking Exclusions

Checking exclusions is a key component of any viable compliance program.  The Office of the Inspector General (OIG) of the US Department of Health and Human Services maintains a list of excluded individuals and entities (LEIE).   Anyone who hires an individual or entity named on the LEIE may be subject to civil monetary penalties (CMP).  […]

Functional Limitation Reporting Claim Rejections

March 13, 2014 8 Comments
Functional Limitation Reporting Claim Rejections

Will it ever stop?  The problems with functional limitation reporting claim rejections that is.  Grant it, there are some confusing scenarios that create provider side problems in coding, but the bigger issue is the continued problems with CMS and the Medicare Administrative Contractors adjudicating claims.  Because of the difference in reporting and adjudication for those reporting on the […]

Writing Functional Therapy Goals

March 11, 2014 9 Comments
Writing Functional Therapy Goals

Are you writing functional therapy goals?  I guess I better take that a step back and ask if you are accurately writing functional therapy goals for a Medicare Plan of Care.   Required elements of the Medicare Plan of care include 1) Diagnoses; 2) Long term treatment goals, and 3) Type, amount, duration and frequency of therapy […]