Tag Archives: center for medicare and medicaid services

Medicare ACOs: The Basics of Financing (Part 3)

In the first two parts of this five-part series, we looked at some background information on ACOs as well as the assignment of Medicare beneficiaries and the limitations on their choices. In essence, there are no limitations on provider choice … Read Full Post

Tagged aco financing, aco's model, center for medicare and medicaid services, cms, health care services, managed care contracts, medical necessity, medicare acos, medicare beneficiaries and the aco, the basics of financing for medicare acos |

HEDIS: Is Yours a Five-Star Health Plan?

To most patients, quality is amorphous; we know it when we see it. To a healthcare administrator, however, quality has a whole other meaning. It’s measurable, measured and a measure of the congruence of several factors. In managed care, quality … Read Full Post

Tagged center for medicare and medicaid services, colorectal cancer screening, health plans, hedis, henry j kaiser family foundation, medical providers, medicare advantage plans, mra, risk adjustment |

Think Your Office is Too Small for Compliance Activities? Think Again.

There are countless reasons for CMS to request records to verify the accuracy and documentation of information submitted for payment; their approach is to ‘pay and pursue.’ Nevertheless, mistakes – no matter how innocent – can prompt prepayment review, which … Read Full Post

Tagged audit, center for medicare and medicaid services, cms, compliance activities, compliance program, corrective action plan, documentation, education, internal policies, proactive providers |

QI, PI, QA – Making Sense of Alphabet Soup (Part 3)

In the first two installments of this four-part series on QI, PI, QA – Making Sense of Alphabet Soup, we discussed the basics of QI and how to create a Quality Study. This blog takes you to the next step … Read Full Post

Tagged auditing, center for medicare and medicaid services, compliance, corrective action plan, home health agencies, qi committee, qi process, quality improvement, supervisory visits |

Home Health Services Require Ordering Provider’s NPI

To receive payment for home health services, any Medicare-enrolled Home Health Agency must file claims containing the name and National Provider Identifier (NPI) of the physician who ordered the service. When billing for an ordered home health service: The individual physician … Read Full Post

Tagged center for medicare and medicaid services, home health billing, home health services, Imark consulting, medicare enrolled home health agency, national provider identifier, requiring ordering provider NPI, tips on home health billing |

Tracking the Details

AHCA, CMS and accrediting organizations require the continuous tracking of certain information, such as educational hours, license expiration dates and insurance coverage, just to name a few. Home health agencies and nurse registries vary in their sophistication and mechanisms to … Read Full Post

Tagged accrediting organizations, AHCA, avoided deficiencies, center for medicare and medicaid services, home health agencies, nurse registries, plan of care, tracking llicense expiration dates, tracking of educational hours |

5010 Update: Extension of Enforcement Discretion Period for Updated HIPAA Transaction Standards through June 30, 2012

(March 15, 2012) The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) is announcing that it will not initiate enforcement action for an additional three (3) months, through June 30, 2012, against any covered entity … Read Full Post

Tagged 5010 update, center for medicare and medicaid services, covered entities, hipaa, home health care billing, homecare billing, Imark consulting, medicaid, medicare, oess, version 5010 compliant transactions |

The Basics of HIPAA (Part 1)

HIPAA is one of the most encompassing legislative changes to happen in the US in the past 20 years. It’s also one that generates a lot of misinformation, myth and sometimes even apathy. A lot of providers believe that securing … Read Full Post

Tagged center for medicare and medicaid services, cms, fraud & abuse, health insurance portability and accountability act, hipaa, home health agencies, medicare integrity program, portability, practice management, the patient protection and affordable care act |