| This week’s note from the instructor is written by Kimberly Anderwood Hoy Baker, JD, regulatory specialist for HCPro.
In my last instructor’s note, I reviewed the many coding and policy clarifications in the April OPPS Update. The April Integrated Outpatient Code Editor (I/OCE) also had a large volume of clarifications and changes to the edits to correct issues with processing claims related to new policies adopted in January. Most of the changes were made retroactively effective back to January, allowing reprocessing of claims that were negatively affect by the edits.
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This week’s updates include new waived tests; guidance to surveyors in conducting exit conferences; and more!
This news article is free for all Medicare Insider subscribers. Click here to read all of this week’s updates. Carefully worded contracts with insurance companies can help avoid ambiguity about the review and appeal process for claims. The sample language excerpted here is from an actual hospital agreement that came about after years of an adversarial relationship between a hospital and insurance company. This sample template is an excerpt from the book Prevent Denials and Win Appeals.
This excerpt is available to Platinum members of Medicare Compliance Watch. Please sign in or subscribe to access the complete excerpt.
There is one newly approved Recovery Auditor issue.
To read the newly approved Recovery Auditor issue, click here.
- Medicare Shared Savings Program ACO: Preparing to Apply for 2017 Call; Tuesday, April 5
- Open Payments 2016: Prepare to Review Reported Data Call; Tuesday, April 12
- IMPACT Act: Data Element Library Call; Thursday, April 14
- Medicare Shared Savings Program ACO Application Process Call; Tuesday, April 19
- National Partnership to Improve Dementia Care and QAPI Call; Thursday, April 28
Events are viewable for all Medicare Insider subscribers. Click here for more details and to register.
Product Spotlight Join us on Tuesday, April 19 at 1 p.m. Eastern to review and analyze the updated discharge planning requirements proposed in CMS’ Conditions of Participation (CoP).
These requirements are not just something hospitals use for auditing on the back end; they are standards every facility needs to follow to enhance patient care. The expansion of these requirements will likely prompt massive changes to case management processes and functions. Although this presents healthcare facilities with new ways to provide value-based services to patients, it may also impact the number of case managers required to ensure compliance with the essential functions of discharge planning. In light of these changes, hospitals, critical access hospitals, nursing homes, home health agencies, inpatient rehabilitation facilities, and others must learn new strategies for evaluating job descriptions, training staff, and altering workflows to maximize the collaborative nature of care transitions.
During this program, expert speakers Jackie Birmingham, RN, BSN, MS, CMAC, and Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, C-ASWCM, ACSW, will discuss practical implications of the proposed discharge planning requirements and what they mean for the everyday routine of case managers and other hospital and postacute care staff members.
At the conclusion of this program, participants will be able to: - Identify the proposed discharge planning requirements as they apply to hospitals and postacute care providers
- Describe strategies to implement current and proposed discharge planning requirements to maximize the workflow of the multidisciplinary team
- List ways to involve the patient in the discharge process that will align with the requirements for meeting patient goals and preferences
- Identify ways to use the discharge planning requirements as tools to decrease unplanned readmissions and improve patient care outcomes
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