While CMS tries to figure out how to proceed with the manual medical review process, we continue to track our caps and apply our modifiers. In the meantime, has anyone noticed how our typical Medicare Part B patients have become more medically complex than just a few years ago?
As a long-term care therapy consultant, I work on a lot of claim reviews and denials management with my clients. I've also read a lot of peer-review research articles related to this subject, and have compiled a list of common mistakes that cause denials. Here's my Top 10 list.
Fuaja Singh completed his last marathon in Hong Kong only a few weeks before he turned 102 years old recently. He said he feels it might be time to retire from running marathons, but he plans to continue running as a hobby. You know what that means.
How do you justify the reason for rehab, length of stay and intensity of treatment? You turn to the 3 C's.
Each time I visited a restroom during a routine site visit, I noticed a very pretty toilet-paper flower there. It was made of toilet paper and folded into a flower, including the stem. It was then sitting in an unused toilet paper roll to serve the purpose of the vase. It was such a clever and creative idea, I wanted to know who was behind this craft.
The Quality Assurance and Performance Improvement system from CMS is on our doorsteps. As facilities have been training and educating themselves, the new QIS (Quality Indicator Surveys) are ready to roll. So, while the entire nursing facility department heads gear up for this new survey process, where does this leave therapy?
Every time we send our patients to the hospital for rehab-related tests, exams or services, these services are billed to Medicare Part B, and, therefore, reduce our cap allowances. Any small oversights could have major impacts on our ability to successfully track therapy cap levels. Here's some help.
The Office of the Inspector General's recent report about what it calls $1.5 billion in inappropriate Medicare payments to skilled nursing facilities should be yet another wake-up call to providers.
Well, we didn't completely go off the "fiscal cliff," but we're definitely heading for a downward slope.
It's hard to believe the holidays are already here. As I have frantically baked cookies, mailed holiday cards and waited in long lines for the perfect gift, I couldn't help but people-watch. I've encountered my share of fellow shoppers that should be posted on various websites for their holiday spirit, or lack thereof.
Rehab Realities is written by Shelly Mesure, MS, OTR/L. She is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide.
